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J Am Geriatr Soc. 2019 Feb;67(2):363-370. doi: 10.1111/jgs.15713. Epub 2018 Dec 13.

Dissemination of the CAPABLE Model of Care in a Medicaid Waiver Program to Improve Physical Function.

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Kirkhof College of Nursing, Grand Valley State University, Grand Rapids, Michigan.
Department of Psychiatry and Department of Statistics and Probability, Michigan State University, East Lansing, Michigan.
College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania.
School of Nursing, Johns Hopkins University, Baltimore, Maryland.



Of older adults, 42% report problems with daily function, and physical function is the most important consideration for aging individuals. Thus, we implemented a model of care focused on improving physical function and examined health and use outcomes and satisfaction.


A 3-year participatory, single-group pretrial/posttrial benchmarked to a usual care cohort that was evaluated prior to the study.


Four Medicaid home and community-based waiver sites in Michigan.


The participants included 34 clinicians and 270 Medicaid beneficiaries 50 years and older.


Community Aging in Place, Advancing Better Living for Elders (CAPABLE), an evidence-based model of care that improved physical function in older adults, was implemented using evidence-based strategies.


Characteristics (age, race, and sex), health outcomes (comorbidities, instrumental/activities of daily living [I/ADLs], pain, depression, and falls), and emergency department and hospitalization visits preintervention/postintervention and in the usual care cohort were examined. We also measured Medicaid beneficiary's satisfaction with care for those who received CAPABLE.


Improved mean ± SD ADLs (preintervention, 8.51 ± 3.08; postintervention, 7.80 ± 2.86; P = .01) and IADLs (preintervention, 6.43 ± 1.31; postintervention, 5.62 ± 1.09; P < .01), a decrease in falls by 14% (from 34.8% preintervention to 20.8% postintervention; P < .01), and fewer hospitalizations (from 0.43 ± 1.51 preintervention to 0.23 ± 0.60 postintervention; P = .03) were found. Post-CAPABLE means were significantly better compared with a usual care cohort for IADLs (6.73 ± 1.27; P < .01) and hospitalizations (0.47 ± 2.66; P < .01). Satisfaction with care was high, and 98.1% recommended CAPABLE as a way to help remain living in the community.


Improved ADLs and IADLs, a reduction in fall rates, fewer hospitalizations, and high satisfaction with care occurred in this population as a result of the use of CAPABLE. CAPABLE may be one solution to helping vulnerable, low-income older adults with poor physical function to remain living in the community. J Am Geriatr Soc 67:363-370, 2019.


Medicaid waiver; adaptation; evidence-based model; implementation; physical function


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