Content area
Full Text
Low-resourced older adults with functional difficulties in Baltimore got help from local occupational therapists, nurses, and carpenters, as part of an extensive, ongoing study.
Providing environmental modifications, including assistive devices and home modifications, is one of the core aspects of occupational therapy practice with older adults with functional disability. Convincing evidence shows that addressing functional challenges at home through environmental modification can have a positive effect on older adults' occupational performance and level of independence in a cost-effective way (Stark et al., 2017). Older adults typically live in older homes, which may necessitate a wide range of modifications for safe functioning at home. This is particularly the case for older adults with low income who may live in poor housing stock (Golant, 2008). This article describes environmental modifications provided in homes of low-resourced older adults with functional difficulties and the range of their costs as part of a study evaluating the program Community Aging in Place, Advancing Better Living for Elders (CAPABLE), which provided home visits in Baltimore by occupational therapists (OTs) and nurses.
Participants and Recruitment
CAPABLE seeks to reduce hospitalization and nursing home admissions among low-resourced older adults living in the community. Based on a theoretical foundation of person-environment press (Lawton & Nahemow, 1973) and resilience (Szanton & Gill, 2010), the program aims to enable older adults with functional challenges to age in place. It is a 5-month-long program with up to 10 home visits, including six sessions with an OT, four sessions with a nurse, and approximately $1,300 of environmental modifications identified by the OT and provided by a licensed handyman. The environmental adjustments support the self-identified functional goals the older adults describe as most important.
The main goal of the CAPABLE program is to promote self-efficacy, with the client acting as the driver of change. The program aims to show respect for the client's beliefs, and understanding of the client's cultural context, with these principles shaping all aspects of the program. Further, the clinicians use problem-solving techniques to reach solutions with the client that are tailored to the client's needs, circumstances, and interests.
Participants eligible for the CAPABLE program study were community-dwelling adults aged 65 years or older, were dually eligible for Medicare and Medicaid, reported difficulty or dependence in...