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Hopkins program aims to keep elderly at home

MedicareMedicaidU.S. Department of Health and Human ServicesHarry and Jeanette Weinberg Foundation

When an occupational therapist walked through the home of 70-year-old Carol Glover two years ago, she immediately noticed safety hazards.

Scatter rugs throughout the single-family home in Ednor Gardens left Glover, who has balance problems, vulnerable to tripping. She held onto the wall when she washed her feet in the bathtub, also leaving her open to slipping and falling. And because there was no ramp in her front yard, Glover dragged her walker up a grassy hill.

But, thanks to a Johns Hopkins School of Nursing program, contractors fixed the hazards and Glover's home is now a safer place.

The program aims to improve the living standards of elderly Baltimore residents so they can remain in their own residences rather than move to a nursing home. In addition to handyman services, participants are paired with an occupational therapist and nurse who teach them how to prevent falls and take medication correctly.

Organizers of the program say keeping seniors at home could save billions of dollars a year in medical costs by reducing nursing home admissions and hospitalizations. Functional decline is the main reason elderly people end up in nursing homes.

Studies have shown that living at home is better for the mental health of seniors, who are happier in a familiar environment where they can live independently.

"So much about aging has to do with managing activity," said Sarah L. Szanton, a Hopkins associate professor who heads the program. "First, people have to have their basic needs met and be able to get around. It's very basic things that the rest of us take for granted."

Glover was part of a pilot program two years ago that made improvements to the homes of 40 elderly people. Hopkins received a $4.1 million grant from the U.S. Department of Health and Human Services' Center for Medicare and Medicaid Services this summer to continue the program, which will help 500 more seniors in the next three years and save the government $6.8 million.

It costs about $3,000 to make the improvements on each elderly person's home under the Hopkins program. A nursing home stay costs $75,000 to $100,000 a year, Szanton said.

The program accepts seniors who are eligible for both Medicare and Medicaid. This population costs the government $315 billion a year, Szanton said.

Researchers at the Harry and Jeanette Weinberg Foundation have found that keeping seniors at home also makes for more stable communities. The nonprofit is in the midst of a three-year caregiver project studying the care of chronically ill or disabled low- and moderate-income older adults. Among its many findings, the project determined that home modifications helped an elderly person live at home for 13 months longer than expected.

"Mom can wash herself, but she can't get in and out of the tub," said Michael Marcus, director of Weinberg's older-adults program. "Every time mom wants to bathe, somebody has to come help her. But if you put in grab bars and other modifications, she can do it herself."

Baltimore's Office of Aging is working with Hopkins to get the word out about the program and help identify qualified seniors. Szanton hopes to make her program a national model.

"People want to stay in the community as long as they can, and this helps people do that," said Arnold Eppel, director of Baltimore's Office of Aging.

When occupational therapist Allysin Bridges first visited with Glover, she noticed the elderly woman was straining to reach objects that were too high and tripping over rugs throughout the house. Like many elderly people, Glover had learned to adjust.

"I realized I was catching my feet on everything, but I just got used to it," Glover said.

As they adjust, elderly people leave themselves open to injuries, Bridges said.

"They don't realize they're doing something differently, and next thing you know, their shoulder is injured from straining to reach," Bridges said.

Contractors lowered the microwave and hooks in Glover's bedroom closet so she could better reach them. They added grab bars to the bathtub and a second banister to the staircase to help her balance. They also built additional railings near her steps outside and a concrete slab so she could roll her walker.

Bridges worked with Glover on balance and ways to prevent from falling. She taught her to back her legs all the way to the chair before sitting down. Before, Glover would flop down because she felt so unstable. Glover has also begun tai chi and started taking water aerobics at the gym.

Glover said she feels stronger and her balance has improved. It also is easier to move around the house.

"I can go faster," she said with a smile, while walking up the steps recently, holding both banisters."I do everything better."

andrea.walker@baltsun.com

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CAPABLE project

For more information or to participate, contact Alice Delaney at 443-287-1584 or adelane7@jhmi.edu or reach the Baltimore City Office of Aging at 410-396-CARE. The website is nursing.jhu.edu/faculty_research/research/projects/capable/.

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