Program employs a handyman to upgrade low-income seniors’ health

By Ronnie Cohen
Reuters

(Reuters Health) - Assistance from a nurse, an occupational therapist and - in a novel approach, a handyman - made it easier for low-income seniors to perform tasks, like dressing, that are essential for independent living, a new study shows.

Moreover, the study found the innovative program for homebound elderly lifted depression in more than half of participants, researchers reported in Health Affairs.

Lead author Sarah Szanton conceived the idea of adding a handyman to a team visiting older adults in Baltimore during the 2008 recession, in response to a call for grant proposals to put Americans back to work. Szanton, a nurse-practitioner and a professor at the Johns Hopkins schools of public health and nursing in Baltimore, spent years making house calls to low-income, homebound seniors and frequently found their environmental challenges just as pressing as their health challenges.

She routinely saw shaky banisters, poorly lit stairways and slippery bathtubs without grab bars. She watched one woman whose legs no longer supported her weight crawl on all fours to answer the door.

Szanton didn’t get the economic-stimulus grant. But she did win a grant from the Center for Medicare and Medicaid Innovation for her program with the handyman called the Community Aging in Place, Advancing Better Living for Elders, or CAPABLE.

Participants included 234 Baltimore residents, mostly women and almost half living alone. They were at least 65 years old, eligible for both Medicare and Medicaid and unable to perform at least four of eight activities considered essential for daily living. The activities included dressing, walking across a small room, using the toilet, bathing and grooming.

The average cost of the five-month program, which ran from 2012 through 2015, was $2,825 for each participant, according to the report.

At the start of the program, participants had trouble performing half of essential daily activities. By the end of the study period, 75 percent of participants had improved their ability to perform essential living functions, and 65 percent improved their performance on related tasks, such as shopping and managing medication.

Home hazards decreased from an average of more than three to a little more than one, and symptoms of depression improved in 53 percent of participants.

The program began with participants identifying their goals, like being able to climb their stairs, take a bath or shower.

“CAPABLE’s built entirely around what the person wants to do to age in their own home,” Szanton said.

For one woman, a deacon in her church who could no longer hear, the program paid for a $35 personal-sound amplifier. “She looked at me and said, ‘If I had 10,000 tongues, and they could all speak at once, I couldn’t praise the CAPABLE program enough,’ ” Szanton said.

Another participant, Mary Knox, a 78-year-old grandmother, also praised the program in a phone interview.

The program bought her a heating pad and containers to hold her clothes so she wouldn’t have to climb into her attic to store them. The nurse recommended that she quit coffee to reduce incontinence and suggested she take her pain medicine at night so it wouldn’t make her tired during the day. The occupational therapist taught her exercises to strengthen her muscles and reduce her pain, and the handyman installed a bathtub grab bar and changed a cracked mirror on her closet door.

“Anything they thought would be dangerous they took care of,” Knox said. “Anything that was in their power to help me they did. They’re just so patient with me.”

She feels better and is better able to care for herself and her young grandchildren.

Dr. David Reuben, chief of geriatrics at the David Geffen School of Medicine at UCLA, told Reuters Health the program’s benefits were clear. He was not involved with the study.

“The innovation makes a lot of sense,” he said. “Some people’s needs are better met with a handyman rather than with pills.”

But, he said, the question remains: who should pay for a handyman for low-income seniors?

“The really good news is that Medicare has been investing in some of these newer models, and clearly they are thinking outside of the box,” he said. “The question is how to scale them, and thus far, they haven’t had a good solution for that.”

SOURCE: http://bit.ly/2bNpHjv Health Affairs, online September 7, 2016.

09/15/2016 11:47