Givers with an interest in health tend to fund researchers and medical schools in the hope of finding elusive cures and advancing science. Not so common are grants for nursing education and research, even though nurses—who often spend far more time with patients than doctors—are in a position to advance major opportunities to improve care and reduce costs. But when funding is directed to ideas developed by nurses, the impact can be enormous.
One recent gift worth looking at closely is a $2.8 million grant made by the Rita & Alex Hillman Foundation to the Johns Hopkins School of Nursing's Center for Innovative Care in Aging in support of a nurse-driven, aging-in-place model. Hillman’s mission is “to improve the lives of patients and their families through nurse-led innovation.” What’s significant about this latest grant is its support for an innovative project that has the potential to scale to a national level.
The five-year grant will enable Community Aging in Place – Advancing Better for Living (CAPABLE) to “establish the infrastructure required to scale its model nationally.” CAPABLE was developed by principal investigator Sarah Szanton, endowed professor for Health Equity and Social Justice and director of the Center for Innovative Care in Aging at the Hopkins School of Nursing. It is designed as a model of care that keeps older adults functioning at higher levels in their own homes or apartments by providing support to enhance their capacity to live independently.
While there are many home health programs that have been around for years, what sets this program apart is its unusual pairing of home repair handyman services aimed at improving safety and accessibility with nursing and occupational therapy services that improve mobility and address disabilities. Another big payoff is that it reduces healthcare costs.
A Model Based on Experience
Szanton came up with the idea for CAPABLE after making house calls as a nurse practitioner to homebound, low-income, elderly patients in West Baltimore and observing that environmental challenges were often as pressing as health challenges, particularly for those trying to age in place—i.e., stay out of a nursing home. The model was further developed in close collaboration with Laura Gitlin, Ph.D., and other colleagues at the Johns Hopkins School of Nursing.
Sixteen projects in eight states and Australia are currently replicating the CAPABLE model, and an additional 15 sites are awaiting funding and approval for replication in the next six to eight months. This is Szanton’s second grant from the Hillman Foundation: She has previously received funding from the National Institutes of Health, the Center for Medicare and Medicaid Innovation, the Robert Wood Johnson Foundation, the John A. Hartford Foundation, and the AARP Foundation.
A Big Cost Savings
According to the Hillman foundation, CAPABLE costs less than $3,000 per senior but can yield Medicare savings of at least $20,000 over two years by reducing the number of hospitalizations, re-hospitalizations and nursing home admissions. In some states, CAPABLE services are eligible to for Medicaid coverage under Section 1115 waivers and, in some instances, by Medicare Advantage plans.
If CAPABLE were scaled nationally, the program could save Medicare an estimated $6.8 billion annually, even if only one-third of eligible older adults participated and the program saved only half as much as it did in the original trial.
In addition to cost savings are other powerful quality-of-life outcomes. For example, the program has been shown to reduce by half the participants’ difficulties with function and mobility, to improve the ability to do grocery shopping and manage medications, to increase motivation, and to reduce symptoms of depression.
"CAPABLE is built on the simple but powerful idea that addressing what matters most to older adults improves quality of life and saves money for communities," said Szanton. CAPABLE was designed after Szanton spent years in the homes of aging adults and learned the practical barriers that limit their ability to age in place.
A Unique Foundation
While there are various foundations that address aging and care issues—and as a result, often fund work involving nurses—there is not one we can think of that shares the Rita & Alex Hillman Foundation’s laser focus on nursing. For a decade, the Gordon and Betty Moore Foundation was a major funder in this space, but it phased out its nursing initiative a few years ago.
Hillman says its mission is to cultivate nurse leaders, support nursing research and innovations, and disseminate new models of care. Undergirding this is the belief that nurses are “critical to transforming our healthcare system into one that is more patient-centered, accessible, equitable and affordable; one that delivers the high-quality care patients need and deserve.”
To understand the foundation’s focus, we can look at the early years of Rita Hillman’s life. In 1989, she emerged from a serious illness with “a deepened appreciation for the role of nurses.” In a move that changed the direction of the foundation, she sold the Picasso masterpiece “Mother and Child” at auction, and with the proceeds, established the first Hillman Scholarship Program for Nursing in 1990.
According to the foundation, by the time of Rita’s passing in 2007, nearly 1,500 nurses had completed or enhanced their education through Hillman scholarships and clinical mentoring programs.
The CAPABLE award is the largest grant to a single nursing-driven innovation in the foundation’s history. "We believe that CAPABLE has the potential to have a major impact on millions of lives," said Hillman Foundation Executive Director Ahrin Mishan in a press release. "Having supported CAPABLE through earlier phases of its growth and development, we feel privileged to help this exceptional innovation take a critical next step."
A key strength of philanthropy is its role in piloting new approaches and solutions that can be scaled for wider impact. Hillman’s support for a program like CAPABLE is a classic case of that role. If this work achieves its full potential, millions of elderly patients could stay healthier and be spared trips to doctors and hospitals, and billions will be saved. That’s the kind of big win Medicare and the rest of our healthcare system desperately needs as America ages rapidly.