Implementation of the CAPABLE Program Plus Critical Home Repairs Among Older Veterans

TL;DR

A program called CAPABLE-VA, combined with home repairs, helped older Veterans improve their health and ability to live independently at home.

Contribution

The study adapted and implemented the CAPABLE program for Veterans and evaluated its effectiveness and implementation challenges within the VA system.

Findings

Veterans showed significant improvements in health status, daily living activities, and pain after the intervention.

Most participants received home modifications and repairs, which contributed to safer living conditions.

Qualitative feedback highlighted the program's benefits but also noted administrative challenges in scaling it.

Abstract

Effective programs are needed to facilitate aging in place, particularly among the growing number of older adults with functional decline. The Community Aging in Place-Advancing Better Living for Elders (CAPABLE) intervention, delivered by an interdisciplinary team, helps low-income, community-dwelling older adults to address causes of disability at home. We tested the implementation of CAPABLE among older Veterans in The Safer Aging Though Geriatrics-Informed Evidence-Based Practices Quality Enhancement Research Initiative hybrid type III effectiveness-implementation trial. We adapted CAPABLE to fit the Veterans Affairs (VA) context (CAPABLE-VA) and provided one year of implementation facilitation (e.g., training, implementation team meetings) to sites. Implementation outcomes were measured using the RE-AIM framework, effectiveness outcomes (general health status, ADLs, IADLs, falls self-efficacy, depressive symptoms, pain) using pre- and post-intervention assessments, and qualitative outcomes through post-intervention interviews using the PRISM framework. Four sites enrolled 30 Veterans: 53% (n = 16) received the full clinical dose of CAPABLE-VA; 90% (n = 27) received home modifications (e.g., grab bars, walk-in showers, entryway ramps); and 73% (n = 22) received critical home repairs (e.g. repairing or replacing plumbing, flooring, staircases). Veterans reported significant improvements in overall health status (p < 0.001), ADL performance (p = 0.002), depressive symptoms (p = 0.03), and pain (p = 0.01). Interviews with Veterans and staff indicated that CAPABLE-VA made homes safer and aging in place easier, though the program’s administrative burden was noted. These findings underscore the need to pair CAPABLE with critical home repairs for low-income older Veterans, while highlighting the challenges of reaching Veterans at scale with a complex, multi-component intervention within the VA.