Skid Row Housing Trust
Los Angeles, California, 90021, United States
NCT Number: NCT04076319
This pilot project seeks to implement an intervention known as CAPABLE (Community Aging in Place-Advancing Better Living for Elders) for formerly homeless adults living in permanent supportive housing. This home-based intervention that consists of time-limited services (no more than 6-months) from an occupational therapist, a nurse, and a handyman is intended to improve functioning and decrease falls among this population that prematurely ages and is at increased fall risk.
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Notify Me50 year and older
All sexes
Interventional
Not applicable
Los Angeles, California, 90021, United States
Permanent supportive housing (PSH) using a housing first approach is an evidence-based intervention to end chronic homelessness by providing low-barrier affordable housing paired with flexible health and social services. In Los Angeles County (LAC), where the number of PSH units is expected to increase dramatically over the next 10 years, clinical guidelines and/or standards for support services are lacking. This is especially problematic given the that the target population is older and prematurely aging. The chronically homeless population in the United States has an average age approaching 60 years old and experiences accelerated aging, including an elevated prevalence of geriatric syndromes such as functional impairment, falls, and urinary incontinence that can jeopardize PSH tenants' ability to live independently and age in place. Current support services are not equipped to address these needs, which ultimately jeopardizes the success of PSH to maintain high rates of housing stability while tenants "age in place."
The investigators propose conducting a pilot project to implement the CAPABLE model in PSH. CAPABLE, which stands for "Community Aging in Place-Advancing Better Living for Elders" is a client-directed home-based intervention that consists of time-limited services (no more than 6-months) from an occupational therapist, a nurse, and a handyman working collaboratively with the older adult client. CAPABLE was developed to target older adults who are returning to independent living after hospitalization and has been shown to improve functioning (activities of daily living - ADLs and instrumental activities of daily living - IADLs), decrease falls and nursing home admissions, and reduce healthcare costs based on multiple studies including several randomized control trials. CAPABLE has the potential to be used in PSH as a model of support services that can address needs of prematurely aging tenants, which could help transform PSH from an intervention that ends homeless to an intervention that addresses homelessness and supports successful aging in place.
The specific aims of this study are to:
Important to note is that this project was conducted during the COVID-19 pandemic so that adaptations to CAPABLE may be due to the context of the pandemic as opposed to being implemented in PSH.
Healthy volunteers accepted: Yes
Only the study team can determine whether someone qualifies for participation.
Inclusion criteria
Exclusion criteria
CAPABLE is a client-directed home-based intervention that consists of time-limited services from an occupational therapist, a nurse, and a handyman working collaboratively with the older adult client. In most cases, the OT makes 6 visits, the RN makes 4 visits, and a handyman makes 1 to 2 visits to make any modifications to a person's home during a 6-month period. The first visits for the OT and RN are usually 90 minutes each and the later ones are usually an hour each. Visits are spaced to enable older adults to practice new strategies learned in the previous visit. There should be a clear "conclusion/graduation," with the older adult understanding how to use their new skills and apply them to future situations.
Time frame: Change of ability to perform activities of daily living from baseline to 6-month follow up (post-intervention).
The modified Katz Activities of Daily Living (ADL) Index is an 8-item questionnaire that was completed by participants to rate their ability to perform daily activities, such as bathing, toileting, eating, and dressing, across a 5-point Likert scale (1 = no difficulty, 2 = a little difficulty, 3 = moderate difficulty, 4 = a lot of difficulty, 5 = unable to do). Items are summed to obtain a score with minimum and maximum values of 8 to 40, respectively, whereby higher scores represent greater difficulty performing ADLs.
Time frame: Change of ability to perform IADLs from baseline to 6-month follow up (post-intervention).
The Brief Instrumental Functioning Scale will be used to assess ability to perform in six functions: bathing, dressing, going to toilet, transferring, continence, and feeding. Each area is assessed on a five point scale; participants rated their ability to perform daily tasks on a 5-point scale (1 = no difficulty, 2 = a little difficulty, 3 = moderate difficulty, 4 = a lot of difficulty, 5 = unable to do). Items are summed to obtain a score with minimum and maximum values of 8 to 40, respectively, whereby higher scores represent greater difficulty performing ADLs.
Time frame: Change in depression symptoms from baseline to 6-month follow up (post-intervention).
Eight of the nine items in the Patient Health Questionnaire-9 were used to measure depression, rated on a 4-point scale of how frequently participants were bothered by the eight problems during a 2-week period (0 = not at all, 1 = several days, 2 = more than half the days, and 3 = nearly every day). Items are summed to obtain a score with minimum and maximum values of 0 to 24, respectively, whereby higher scores represent greater depressive symptoms.
Time frame: Change of falls efficacy from baseline to 6-month follow up (post-intervention).
Participants rated their confidence they could do each of 10 activities without falling on a 10-point scale, with total scores ranging from 10 (not very confident) to 100 (very confident) using the Tinetti Falls Efficacy Scale. Thus, higher scores indicate greater efficacy related to falls.
Time frame: Change in the degree that pain interferes with usual activities from baseline to 6-month follow up (post-intervention).
Pain interference with usual activities was assessed using an item from the 3-item PEG to assess average pain intensity (P), interference with enjoyment of life (E), and interference with general activity (G) on a 10-point Likert scale from 0 (does not interfere) to 10 (completely interferes).
Time frame: Number of falls in the past year reported at 6-month follow up.
Mean number of falls to the ground during the past year.
Time frame: Change in self-rated health from baseline to 6-month follow up (post-intervention).
Self-rated health was measured on a 5-point scale (1 = excellent, 2 = very good, 3 = good, 4 = fair, 5 = poor). A higher score indicates poorer self-rated quality of health.
Time frame: Change in quality of life from baseline to 6-month follow up (post-intervention).
Quality of life was assessed using a single item: "Overall, how would you rate your quality of life?" Response options ranged from 1 = worst possible quality of life to 11 = best possible quality of life. Thus, a higher value indicated greater self-rated quality of life.
Time frame: Proportion of participants with ER visits in past 6 months reported at 6-month follow up.
History of emergency room visits during the past year assessed by asking: "How many times did you visit the emergency room in the past year (since the last survey)?
Time frame: Number of ER visits in past 6 months reported at follow up.
History of emergency room visits during the past year assessed by asking: "How many times did you visit the emergency room in the past year (since the last survey)? Outcome is the mean number of ER visits in past 6 months.
Time frame: Proportion of participants with hospitalizations in past 6 months reported at 6-month follow-up
History of hospitalization during the past year assessed by asking: How many times did you stay overnight in a hospital in the past year (since the last survey)?"
Time frame: Number of overnight hospitalizations in past 6 months reported at 6-month follow up.
History of hospitalization during the past year assessed by asking: How many times did you stay overnight in a hospital in the past year (since the last survey)?" Outcome measure is the mean number of overnight hospitalizations in past 6 months.
University of Southern California
Other
Implementing CAPABLE in Permanent Supportive Housing
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