Our 2010 Annual Report, “A Day in the Life of an Academic Geriatric Nurse,” includes photographic profiles of 18 nurses who have received BAGNC awards or who play key roles in the program. Today we feature Sarah Szanton, PhD, CRNP, from the Johns Hopkins University School of Nursing, who received a 2005-2007 BAGNC pre-doctoral scholarship award and a Claire M. Fagin 2009-2011 post-doctoral fellowship. She is conducting a research project to help older adults remain in their homes.
JAHF: Your research project attempts to help low-income older adults age in place. Can you tell us how you got interested in this issue?
Sarah: Several years ago, as a nurse practitioner, I made house calls to low-income older adults. In many cases I saw that their home environment was just as disabling as their health problems. I thought if we could fix the holes in their floors, put banisters on their stairs, and repair the loose carpeting we could encourage their mobility and ability to care for themselves, decrease their social isolation, and help with their mood. In Baltimore many people live in row houses with front steps made of marble and no railing. Even if older adults living in these houses can move around within their house, it can be dangerous to leave the house.
We know that not being able to take care of yourself physically is the main modifiable reason that people end up in nursing homes. Most people don't want to be in a nursing home, yet we do little, societally or medically, to help them take care of themselves in their homes.
JAHF: You've adopted a unique approach to team care by including a handyman. Can you describe your project?
Sarah: I became aware of work that Laura Gitlin, PhD, was doing. She's an applied sociologist and a recognized expert in the area of physical function and older adults. Her work involved occupational therapists and small home modifications, which were mostly assistive devices like walkers and grab bars. We pilot tested a project that built on her protocol. It's called CAPABLE. In addition to occupational therapists, we hired handymen to do about $1,000 worth of safety-related home repair per household. We also added a nurse to the team. The nurse identifies medical issues like pain or depression and works with a primary care provider to make sure the person is on the right regimen. If they don't have a primary care provider we find one for them – some even provide house calls.
The first person in our study had fallen out bed. We had the handyman install a grab bar on her bed. An occupational therapist provided training, and now she's no longer at risk for falling out of bed. The idea of our intervention is to put these services together in a way that they act synergistically.
We finished the pilot study in 40 households. On average, each participant was able to do one more activity of daily living, like get out of bed or wash themselves, than when we started. The intervention also significantly reduced their fear of falling, which impacts their mobility. The paper reporting the results has been submitted to the Journal of the American Geriatrics Society, and we've now applied for a grant from the National Institutes of Health for a larger study of 300 households.
JAHF: You've secured funding from both traditional and nontraditional sources. Who has agreed to fund your continuing study?
Sarah: Our next study is partly funded by the Robert Wood Johnson Foundation. But we've also partnered with the Baltimore City Department of Housing. They have agreed to donate all of the housing repairs for 60 households based on what we say needs to be done. This is really remarkable.
JAHF: You are also involved in policy work related to this research. Tell us about the paper you co-wrote for the SCAN Foundation.
Sarah: The SCAN Foundation is collecting evidence to facilitate thoughtful implementation of the Community Living Assistance Services and Supports (CLASS) plan. This program was the brain child of Senator Edward Kennedy, and it was passed as part of the health care reform bill. People can pay into the plan when they are in middle age or older. Once they have participated in the plan for five years they can get a benefit, which is up to $50 a day to pay for services that will help them stay at home. The money can be averaged over time, so they can, for example, use the money to pay for a stair glide. The SCAN Foundation asked me and Laura Gitlin to summarize evidence about what older adults need to be able to stay independently in their homes. We emphasized flexibility because different people have different needs and they change over time. Some of those needs include training for caregivers.
The SCAN Foundation held a webinar that involved state and local policymakers to discuss how to implement the new law, and our paper was included in the discussion. I'm so pleased that the work my BAGNC funding helped support is now informing policy on a national level.
This is the fifth in a series of blogs celebrating the release of our 2010 Annual Report, “A Day in the Life of an Academic Geriatric Nurse.” Links to the series are below: