The Meteoric Rise Of Johns Hopkins’ CAPABLE Program

Sarah Szanton, the dean of Johns Hopkins School of Nursing, has a thing for the tougher challenges in health care. She also has a knack for overcoming those.

That has served her and the CAPABLE program well. That program, of course, is also known as “Community Aging in Place – Advancing Better Living for Elders.”

“People always talk about trying to get the low-hanging fruit, which is a good way to get stuff done,” Szanton told Home Health Care News. “But I think the high-hanging fruit inspires people and can make a North Star.”

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In 2009, Szanton and her colleagues at John Hopkins had an idea for an aging-in-place program that would combine nursing care, occupational therapy and handyman services.

Early indications of the program’s success were promising. Clients who had serious disabilities were getting around and making substantial progress. Caregivers and nurses would come to Szanton with tears in their eyes and stories of how meaningful the work was.

“To see them change over time, not just being able to do more things, but the psychological change that was happening with people as they were able to engage more with their family or go somewhere, was really apparent,” Szanton said. “So before we had the research data, it was clear there was something really potent happening with CAPABLE.”

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The story behind CAPABLE

CAPABLE is an interdisciplinary program that was created at the Johns Hopkins School of Nursing. It puts an emphasis on modest investments and short-term interventions to improve the quality of life and health of aging adults at home.

The program is non-clinical and puts the power of the care plan in the hands of the patient. Instead of having a clinician come in and run through a to-do list, CAPABLE allows the adult to curate their care plan based on what they want to improve.

Through the three pillars of CAPABLE care, caregivers collaborate with clients to increase mobility and functionality in the home. The program usually takes between four and five months and includes goal setting, action planning and recorded improvements for activities of daily living (ADLs).

The success of the early trial programs was evident in pilots in Greensboro, North Carolina; Burlington, Vermont; San Diego and Scranton, Pennsylvania.

“They got the same results [in those cities] that we did and they sustained for a year,” Szanton said. “That was when I first started to feel like this isn’t just something magical or a one-off. This is transmittable to other people who haven’t had the lived experience that we have. There isn’t just a magic connection in Baltimore through our great team. Then I started to really think about what the policy levers would be to sustain this and grow it.”

Early on, Szanton and her team focused on low-income adults and Medicaid beneficiaries who needed help aging at home.

“The reason to focus on low-income people, initially, was both a social justice perspective and making sure we had the right pockets paying and averting the costs,” Szanton said. “As it resonated with more people and as we saw that hospitalizations were reduced as well as nursing home stays, it made us start to think about Medicare eligibility itself, which meant that we could be thinking about Medicare Advantage and other policy aspects.”

CAPABLE’s growth aligned perfectly with the overall health care financing shift toward patient-centered outcomes.

“The way health care is financed is moving towards patient-centered outcomes, patient satisfaction and patient engagement,” Szanton said. “CAPABLE is off the charts in terms of that. People love it, it makes them love their health plan, it makes them trust the health plan and be more engaged in primary care.”

Over the course of 12 years, CAPABLE expanded to over 25 cities. Now, the program is on the cusp of another major growth period.

Care Synergy makes its pitch

Before being named the SVP of operations at Care Synergy, Tricia Ford was the interim president of the nonprofit while the company looked for a permanent hire.

The Colorado-based Care Synergy is a network of community-based home health care, hospice and palliative care providers.

During the search, Ford had several talks with the Colorado Visiting Nurse Association (Colorado VNA), which had been providing CAPABLE services in the Denver area since 2017.

A couple of years ago, CAPABLE put out an RFP for a company to take over and become the national hub for the program’s sites around the country through a partnership with John Hopkins.

Because she had seen how effective the program was, Ford believed in its future potential. She also knew Care Synergy could handle the transition.

“We have the payroll, the infrastructure in place, the marketing, the media sections, business development, you name it,” Ford told HHCN.

When Care Synergy was put on a short list of companies to be interviewed, Ford was quickly out on a flight to Baltimore. After a “rigorous” interview process, the nonprofit won the bid.

“The pitch was twofold: we have the infrastructure to operationalize it and we already had an understanding of the CAPABLE services because of CVNA,” Ford said.

The Care Synergy news was officially announced in October, and Ford said that the program is now operationally under the Care Synergy umbrella.

She said that the simple – yet specific – strategies CAPABLE uses are a key factor in the program’s success.

“We have to do a better job — as a country and as a health care system — to arm people with resources, provide them with skills and teach them how to remain in their home,” Ford said. “It could be as simple as moving an area rug so they don’t trip on it. They might not have adequate lighting because they have an older home. It could be changing the door knobs to levers so they can move around easier. Those are minor adjustments in a house that we can take care of that will make an incredible difference for them to remain in their home for years.”

It also challenges and encourages CAPABLE clients to think on their own and come up with their own solutions to problems they struggle with. There is value in that autonomy, she said.

It’s also a refreshing model for Ford, who worked for years in the hospice space, which can be very structured.

“This is teaching people upstream and how to make those choices for themselves so that they’re confident when their health care trajectory is changing,” Ford said. “They’re taking a more active approach in their care.”

Now that CAPABLE is up and running under Care Synergy, the next step is continued growth.

Continued expansion

By most measures, CAPABLE has been a success. However, Szanton doesn’t feel like the program has scratched the surface on what it can really do.

“I think CAPABLE is a success in many ways. It also has not reached its full potential by any means,” she said. “It’s a success through the lens of the broadening health care system that no longer relies on medical visits in institutions. It’s now in the board exam if you want to be a geriatrician. It’s now in 24 states, and some of them statewide. But it’s really only touched less than 10,000 adults. We’ve estimated, using population data, that about 14 million people per year could benefit from this. So 10,000 is kind of a drop in the bucket if you look at it that way.”

That’s where Care Synergy comes in.

Already, Care Synergy has already secured a handful of partnerships around the country with the goal of 15 in the first year.

“It is blowing up,” Ford said. “If you talk to my admin, she’ll tell you that every day she is trying to find three or four different appointments. It’s crazy. Ten states are in various places or processes to do some type of pilot for their Medicaid membership. My personal goal is to enroll 15 new sites in the first year. In the first quarter we did three. It sounds like I’m not ahead of my goal, but if you saw how many that we have that are in process, that’s going to be easy to hit.”

CAPABLE and its leaders are still reaching for the high-hanging fruit. Now, they’re just looking for more of it.

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