For older adults, the ability to remain safely and independently at home can come down to something very personal: being able to do the things that matter most to them.
That's one of the principles at the heart of CAPABLE, a client-directed, in-home program that brings together occupational therapy, nursing, and home-modification support to help older adults achieve their own goals.
In a recent interview with The Home Accessibility Therapist, Ally Evelyn-Gustave, CAPABLE Clinical Training Specialist, shares her perspective on the model and the important role occupational therapists play in helping older adults live safely and independently at home. With nearly two decades of experience in CAPABLE implementation and clinician training, Ally brings a wealth of knowledge to the conversation.
CAPABLE is designed around the individual. Over the course of approximately four to five months, the older adult works with an occupational therapist, nurse, and handyworker to identify goals and develop practical solutions.
Those solutions don't have to involve major renovations. Sometimes a relatively simple change can make a meaningful difference: a properly placed grab bar, improved lighting, a railing, a flexible shower hose, a repair, or an everyday tool that makes a task easier.
The key is determining what will work for that particular person.
Ally explains that occupational therapists bring a unique perspective because they look at the relationship between the person, what they need and want to do, and the environment in which they are doing it. For example, rather than simply installing a grab bar according to a universal standard, an OT can observe how an individual actually moves and determine where support would be most useful for that person.
CAPABLE isn't about walking into someone's home and telling them what needs to change.
Client choice is fundamental to the model. Through listening, motivational interviewing, and relationship building, CAPABLE teams help older adults identify their own priorities and participate in developing solutions that they are more likely to use and sustain.
That approach is especially important when conversations involve sensitive issues in the home. Ally shares her experience taking The Home Accessibility Therapist's course on working with individuals with hoarding disorder. She appreciated the course's emphasis on understanding the reasons behind acquiring and retaining possessions, using motivational interviewing, and supporting meaningful behavior change rather than simply telling someone to declutter.
Those principles closely align with CAPABLE's broader philosophy: listen without judgment, honor the client's choices, and work together toward achievable improvements.
Research on CAPABLE has demonstrated meaningful outcomes, including improvements in activities of daily living, mobility, and fall reduction, as well as reductions in emergency-department visits and hospital use across different populations.
At the center of those outcomes is a simple but powerful idea: the person receiving care should help define what success looks like.
For Ally, that client-centered philosophy also makes occupational therapists with specialized training in home accessibility a strong fit for CAPABLE teams. Their experience with home assessments, individualized environmental recommendations, motivational interviewing, and collaboration with contractors and other professionals can help translate an older adult's goals into practical home solutions.
While CAPABLE is delivered through organizations that implement the program rather than independently by individual clinicians, additional home-modification education can help therapists bring these skills to CAPABLE teams as well as to home health, private practice, and other community-based settings.
We invite you to watch Ally's full conversation with The Home Accessibility Therapist to hear more about CAPABLE, the role of occupational therapy, and the importance of putting the older adult's goals at the center of the work.