Health Outcomes of CAPABLE in Permanent Supportive Housing

A model of care known as Community Aging in Place, Advancing Better Living for Elders, or CAPABLE, is an evidence-based intervention designed to improve physical function among independent living, low-income older adults. It consists of a 10-session home-based program delivered over 5 months by an occupational therapist, registered nurse, and maintenance worker to address an older adult’s capabilities and home environment.

Previous research has shown that CAPABLE improves basic and instrumental activities of daily living (ADLs, IADLs) as well as overall cost savings across multiple clinical trials with older adult populations. Our team conducted a pilot randomized controlled trial of CAPABLE in permanent supportive housing (PSH), which is an evidence-based intervention to address homelessness. A significant portion of the population that now resides in PSH is also at high risk of premature onset of geriatric conditions that can jeopardize one’s ability to live independently. Indeed, the target population for PSH includes people considered to be chronically homeless who have an average age just under 60 years old but experience significant accelerated aging.

Initial findings established that CAPABLE can improve outcomes in PSH where tenants are on average younger but have higher rates of chronic mental health conditions than the typical target population for CAPABLE. The pilot study also identified that CAPABLE clinicians need training on and/or referrals to psychiatric rehabilitation when working in PSH.

The proposed 5-year study is to conduct a large-scale randomized control trial of CAPABLE versus usual care in PSH, which consists of intensive case management services (ICMS). This study will be conducted in partnership with the Los Angeles County Department of Health Services that provides services to over 20,000 PSH tenants. A total of 634 PSH tenants who have ADL or IADL limitations will be randomized to either receive CAPABLE or usual care. Study participants will be surveyed at 5 time points (0-, 3-, 6-, 9- and 12-months) so that those who receive CAPABLE can be followed for 6 months after the intervention, which can take between 5 to 6 months to complete. Qualitative interviews with CAPABLE clinicians, recipients, and their ICMS workers will also be conducted.

The goals of the study are to: Examine the impact of CAPABLE on PSH tenants’ ADLs and IADLs; Compare the cost-effectiveness of CAPAPBLE versus usual care; And consider any barriers or facilitators to implementing CAPABLE in PSH.

Funding

Type	Source	Number	Amount	Period
Federal	NIH / National Institute on Aging	R01 AG094859	$5,105,041	Sep 2026 – Aug 2031

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