As a young policy analyst for a women’s health organization in the 1990s, Sarah Szanton, PhD, RN, MSN, looked on in admiration as nurses used their insights into health care to educate policymakers in Washington, D.C. She realized that she could have more influence on health and health care as a nurse and nurse scientist than as a policy analyst, so she decided to become one.
After earning her bachelor’s and master’s degrees in nursing, Szanton cared for migrant workers in rural Pennsylvania and for homeless and elderly people in inner-city Baltimore—positions that gave her an inside look into the challenges to health posed by poor living conditions.
Yet many low-income elderly people lack the ability and the resources to modify their homes so they can live there as long as possible—as most Americans want to do. The health care system is of little help. In large part, it fails to recognize how housing affects health, which leaves many low-income frail elderly in one of two undesirable situations: improperly cared for in their houses or forced to live in nursing homes at great personal or taxpayer expense.
Szanton decided to earn a doctorate in nursing so she could study ways to solve the problem. Now an associate professor at the Johns Hopkins School of Nursing and an alumna of the Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars program
, she is researching ways to make it possible for low-income older adults to live in their own homes for longer periods of time. Her “a-ha” moment came when she realized the potential impact home maintenance workers could have on health. With simple tools and at a relatively low cost, she believed, handymen and women could turn dangerous houses into safe and healthy homes.
She devised a program called Community Aging in Place, Advancing Better Living for Elders, or CAPABLE, which sends teams of nurses, occupational therapists, and home maintenance workers to the homes of low-income, frail elderly participants. After an assessment of all functional areas, the participant decides on functional goals, such as taking a bath or walking to church, as opposed to medical ones, such as reducing blood sugar or blood pressure levels. Studies of the program have found that it improves function, health, and quality of life.
Participants aren’t the only beneficiaries. The program costs about $4,000 per participant, but it may save taxpayers an average of $10,000 per participant because it helps reduce hospitalizations and placements in nursing homes, which cost about $75,000 to $100,000 per year per beneficiary. Szanton has since received grants from the National Institutes of Health and the Centers for Medicare & Medicaid Services to further study the effects of the program and potentially make it available on a nationwide scale.
“We feel like we’re really on to something,” she says.