Libbey Bowen, an associate professor in the School of Nursing, is working with a nationwide team of interprofessional investigators to improve healthcare for older veterans as part of a $5 million initiative from the U.S. Department of Veterans Affairs.
Bowen is a co-investigator on a Quality Enhancement Research Initiative (QUERI) from the VA, focused on implementing evidence-based practices that improve care and safety for older veterans.
As part of QUERI, Bowen will lead implementation of the Community Aging in Place – Advancing Better Living for Elders (CAPABLE) project to help older veterans live safely in their homes and avoid unnecessary hospitalizations. CAPABLE is a patient-centered intervention that brings home-based nursing and occupational therapy to patients, along with someone to provide minor home repairs to increase patient safety at home.
The five-year QUERI will implement practices that make up the Age-Friendly Health System model in a network of VA medical centers and community-based outpatient clinics. The network includes nine VA medical centers – the Wilmington VA Medical Center among them – and more than 40 community-based outpatient clinics that together serve over 300,000 patients annually.
“In this project, we identified a gap in services for older adults who don’t need as much in terms of home services to maintain independence,” said Bowen, a gerontologist whose research focuses on maintaining function among older adults. “They do need someone to come in and evaluate their living environment, reconcile their medications, provide minor home repairs —install a raised toilet seat, grab bar – to continue to live in their home longer. We have not provided these home-based services to frail older veterans.”
The CAPABLE project was first developed at Johns Hopkins University and has since been expanded to more than a dozen states. This is the first time the project will be part of the VA, and its implementation in a larger health organization will offer the chance to learn even more about CAPABLE, said Sarah Szanton, a professor in the Johns Hopkins School of Nursing who first developed and implemented the project in academic and nonprofit settings.
“CAPABLE has already served more than 2,000 older adults across the country and Dr. Bowen’s leadership of the CAPABLE implementation in the VA will bring her expertise in functioning, which will have a large impact on older veterans,” Szanton said. “Helping older veterans maintain their independence in the community longer will improve their quality of life and have meaningful ripples throughout the veteran community.”
Through the CAPABLE project, older veterans will be visited by an interprofessional team, including an occupational therapist who will work with them to identify up to three personal goals related to aging in place, such as being able to fix a meal or bathe without assistance. While a nurse assesses overall patient health, the OT will then determine what needs to be done in the home to make those goals possible. Home repair services and modification also will be provided based on recommendations from the team.
In addition to her work at the University of Delaware, Bowen also has a joint appointment with the VA, where she works at centers in Philadelphia, Coatesvile and Wilkes-Barre, Pa. The VA also funds some of her research in the School of Nursing.
Although the VA’s rollout of CAPABLE will begin in October, Bowen said work is going on now to develop partnerships and purchase equipment. One goal is to have home repair services performed by veteran-owned businesses to increase their participation and inclusion in the program.
Dr. Robert Burke, one of the multiple principal investigators on the overall QUERI center, said CAPABLE complements and augments the home-based services the VA provides to allow them to successfully age in place. “We see it as a cornerstone of efforts the VA is engaging in nationally to respond to the needs of the growing older veteran population, ensuring they receive age-friendly evidence-based care at every healthcare encounter to maximize their quality of life,” said Burke, an investigator with the VA Center for Health Equity Research and Promotion. “We hope to learn through this project how best to implement evidence-based practices like CAPABLE in VA settings, allowing national dissemination.”