Supported by a $10,000 Hartford Change AGEnts Action Award, a small pilot program to provide team-based home care and home repair services to a handful of people in Saginaw, Michigan, has blossomed into a larger effort to help 270 of the state’s most vulnerable older adults in three cities stay in their homes and communities, potentially leading to statewide spread.
“Closing the gap between knowledge generation and making systematic, large-scale practice change is challenging. The Hartford Change AGEnts Initiative connected me to a community of scholars, clinicians, and leaders; trained me to build interventions embedded in practice; helped me tell my story to engage policymakers; and accelerated practice change in a Medicaid program, where some of our nation’s most vulnerable are cared for.”
-Sandra Spoelstra, PhD, RN
Sandra Spoelstra, PhD, RN—co-leader of the MiCAPABLE program along with fellow Hartford grantee Sarah Szanton, PhD, ANP—leveraged the initial support from Hartford to first gain a $10,000 matching grant from the state of Michigan, and then to help win a prestigious $600,000 Innovations in Care Award from the Rita & Alex Hillman Foundation, which also was matched by a $600,000 grant from the state.
Sandra Spoelstra meets with one of the 20 older adults dually eligible for Medicare and Medicaid involved in the MiCAPABLE pilot program in Saginaw, MI, funded by a Change AGEnts Action Award and a match by the state.
“We reviewed more than 260 different Innovations in Care applications,” notes Ahrin Mishan, executive director at the Rita & Alex Hillman Foundation. “The MiCAPABLE program stood out as a nurse-led innovation that will improve the care of a group of vulnerable older adults. We were pleased to augment the Hartford Action Award and help to broaden the impact of this promising model.”
Beyond the Action Award, the MiCAPABLE program has also benefited from other parts of the Change AGEnts Initiative. Dr. Spoelstra was instrumental in starting a collaborative, interdisciplinary Change AGEnts group that comes together for monthly conference calls to discuss how best to translate scientific materials into the real world setting. “There’s a big barrier there. Scientists and clinicians talk different languages,” she says.
And she was also able to share information and get different perspectives from colleagues across disciplines at the first annual Change AGEnts conference in Philadelphia in December 2014.
The original CAPABLE program, on which MiCAPABLE is modeled, was launched by Dr. Sarah Szanton and her team of investigators including Dr. Laura N. Gitlin, occupational therapists, and nurses at the Johns Hopkins School of Nursing. Dr. Spoelstra had followed Dr. Gitlin’s foundational work and Dr. Szanton’s adaptation of that work over the years. When Dr. Spoelstra received a Hartford fellowship to attend the Johns Hopkins Summer Research Institute for Developing and Advancing Behavioral Interventions in 2013, she realized that the intervention could be brought to Michigan.
Where the original CAPABLE program involved nurses and occupational therapists, the MiCAPABLE program has added social workers to the mix. Older adults participating in the program receive 12 weeks of home visits from a team that includes a registered nurse, a social worker, and an occupational therapist, to ensure that health needs are met, and a handyman, to accommodate the home to the needs of an aging adult. The team’s work might include activities like training to help avoid falls and the installation of bathroom grab bars and other home modifications.
Michigan’s Medicaid waiver program for home and community-based services supports people coping with a range of daunting issues—medical, economic, social, physical, emotional, and others—as they strive to live at home instead of in a nursing home. The average age of those in the waiver program is 78. The average number of medications taken by the older adults in the population is a staggering 17. (Dr. Spoelstra recalls one older man who was on 42 different medications when he started the program.) The average fall rate—one of the most significant risks to maintaining independence—is 35 percent. And these frail elders are living at less than 300 percent of the poverty level.
While Michigan’s waiver program offers a package of 19 wraparound services that includes snow shoveling, personal care, meals on wheels, and adult day care, Dr. Spoelstra says the program was not “using the best evidence possible. They want to, it’s just that they’ve never had anyone collect it and figure out how to deliver it in a meaningful manner that was useful to the staff and the participants.”
Currently, the one-year pilot program in Saginaw funded by the Hartford Change AGEnts Action Award and a $10,000 match by the state of Michigan serves 20 older adults who are dually eligible for Medicare and Medicaid. With the infusion of funding from the Rita & Alex Hillman Foundation and the state of Michigan, the program will expand to two new sites—Detroit and Flint.
Dr. Spoelstra credits the “100 percent engagement” of Elizabeth Gallagher, manager of the Michigan Department of Community Health’s home and community-based services section, with helping to advance MiCAPABLE. When the three-year Rita & Alex Hillman Foundation grant ends, the state has committed to embedding the intervention within state policy for the Medicaid waiver program, she adds.
“So it has significant policy implications in addition to improving the quality of life of our most vulnerable citizens, as well as saving money,” Dr. Spoelstra says.
