Fields, who also serves as director of the Geriatric Health Services Research Lab at UW–Madison, has dedicated her career to developing patient and caregiver-centered interventions for both hospital and home settings. Her work stems from a unique perspective shaped by her roles as clinician, researcher, and family caregiver.
“We aim to foster collaboration to address challenges of aging and caregiving,” said Fields. “Our goal is a society that's more physically, socially, emotionally, and financially supportive of aging adults and those providing care to them.”
CAPABLE: Helping Older Adults Age in Place
The first innovation Fields discussed was CAPABLE (Community Aging in Place Advancing Better Living for Elders), an evidence-based program developed at Johns Hopkins University. This four-month intervention brings together an occupational therapist, a registered nurse, and a handyperson to provide assessment, education, and problem-solving techniques to help older adults remain in their homes safely.
“Previous studies have demonstrated CAPABLE’s effectiveness in reducing disability, lowering inpatient and long-term service use, and decreasing Medicaid spending,” Fields explained.
While CAPABLE has expanded to more than 40 sites across 21 states, Fields noted that Wisconsin is not yet among them. “I’ve started talking with folks at the Department of Health Services and some other community agencies to talk through implementation,” she said, hinting at future possibilities for state residents.
Riding in the Moment: Therapeutic Horsemanship for Dementia
The second innovation, Riding in the Moment, offers adults with early to middle-stage dementia the opportunity to engage with horses in a therapeutic environment. Initially developed in Colorado, the program provides participants with riding, grooming, and socialization activities designed to enhance their quality of life.
“Our research has shown that this adaptive riding program is safe, well-received, and improves the quality of life for older adults with dementia,” Fields stated. The program aims to reduce sensory deprivation, social withdrawal, and functional decline.
In 2019, Fields discovered that none of Wisconsin’s 25 riding centers offered programming specifically for older adults or those with dementia. Thanks to her efforts, Riding in the Moment is now available at two Wisconsin locations — Neenah and Stoughton — with a third location launching soon in Cedarburg.
“Our goal is to build on this momentum, raising awareness and working toward offering this program at all 25 centers across our state,” Fields said.
DCHAT: Supporting Caregivers during Hospital Stays
The final innovation addresses the often-overlooked needs of caregivers who support a relative or partner living with dementia, while that person is hospitalized. The Dementia Care Partner Hospital Assessment Tool (DCHAT) uses a questionnaire to identify the care partner’s needs and preparedness. Hospital staff are then able to tailor referrals that address both the care partner’s stated preferences and their unmet training needs to ensure successful and sustainable caregiving after their loved one returns home.
“Caregivers are the backbone of our long-term care system,” Fields emphasized. “I firmly believe that caregiver health and well-being should be recognized as a public health issue on par with efforts like smoking cessation, obesity prevention, and cancer surveillance.”
DCHAT is currently being tested in a clinical trial at UW Health University Hospital, with plans to expand to East Madison Hospital within the next few months. The trial aims to assess whether this tool helps reduce emergency room visits and patient readmissions while improving key caregiving outcomes like preparedness, burden, and depression.
Looking Ahead
According to Fields, these innovations share important goals: to help ensure at-risk individuals don’t become high-risk patients, to involve interprofessional teams in addressing a wide range of needs, and to adhere to federal and state policies aimed at improving geriatric and caregiving services.
As the population continues to age, Fields sees these programs as crucial components of a more inclusive and effective health and social service system. However, she acknowledged concerns about sustainable funding for such initiatives, especially given current budget constraints.
“If federal dollars are in the hands of the states more than they have been, then I think it’s going to be really important that people to advocate,” Fields suggested, highlighting the importance of community involvement in securing support for aging-related programs.
