Pilot Study of CAPABLE Care Connect Program for Homebound Older Adults to Improve Social Connection and Daily Function

What this Trial Is About

Researchers are evaluating the CAPABLE Care Connect program, a home-based, interdisciplinary, and goal-directed approach designed to reduce physical disability and improve quality of life for homebound older adults who may experience social isolation and loneliness. This mixed methods study aims to adapt and test CAPABLE within home-based primary care settings, exploring how combining CAPABLE with Johns Hopkins Home-Based Medicine JHOME might enhance health, function, and social connections for people living with disabilities and their caregivers. The CAPABLE Care Connect intervention involves a tailored package of services delivered over four months by an occupational therapist, a registered nurse, and a handy worker. Participants receive approximately six home visits from the occupational therapist, four from the nurse, and visits from the handy worker, each lasting up to one hour. The study includes an open-label pilot phase and a pilot intervention phase, recruiting caregiver-patient pairs and individuals without caregivers. A comparison group consists of JHOME patients receiving standard care to evaluate the interventions effects. Participants will engage in baseline and 16-week assessments measuring changes in activities of daily living, pain, depression, social connection, and caregiver burden using various standardized scales. Health system effects such as urgent visits, emergency room visits, nursing home placement, and medication use are also tracked. The study involves virtual or in-person meetings lasting 45 to 60 minutes and monitors outcomes over 16 weeks, with a total sample size including both intervention and standard care participants of up to 450 individuals.

CAPABLE Care + Connect