title: Independent Living Capacity Evaluation in Home-Based Primary Care: Considerations and Outcomes of a Quality Improvement Project.
abstract: This article describes results of a quality improvement project review of 5 years of capacity evaluations for independent living conducted in one Home-Based Primary Care (HBPC) Program.
  
  
  
  A retrospective chart review was conducted for all patients evaluated for independent living capacity through the Boston VA HBPC Program (N = 25) to identify differences in outcomes for those with and without capacity. Descriptive information included referral sources, capacity decisions, time remaining in the home, and trajectory of patients following evaluation.
  
  
  
  All patients evaluated had been diagnosed with a cognitive disorder, and on average, a relatively lower prevalence of mental illness compared with the national HBPC population. Referrals were made primarily by the HBPC team. Patients with capacity were found to have remained in their home longer than those who lacked capacity.
  
  
  
  Referral for a higher level of care was typically only recommended when no further intervention could be implemented and active risk in the home could not be managed.
  
  
  
  In home capacity evaluations are complex and challenging, yet results help family and HBPC team support patients' preferences for staying in their own home as long as possible.
authors.affiliation: Executive Mental Health, Los Angeles, California, USA.
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Feng
authors.affiliation: VA Boston Healthcare System, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Margaret R
authors.initials: MR
authors.lastname: Murphy
authors.affiliation: VA Boston Healthcare System, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Mlinac
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D060825:Cognitive Dysfunction / Q000150:complications / Q000523:psychology; D005260:Female; D015577:Geriatric Assessment; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D057187:Independent Living / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010342:Patient Acceptance of Health Care; D057240:Patient Preference; D011320:Primary Health Care / Q000458:organization & administration; D058996:Quality Improvement; D012189:Retrospective Studies; D018570:Risk Assessment
keywords: Decision-making capacity; home-based primary care; home-based services; independent living capacity; interdisciplinary