SASH® (Support And Services at Home)
- Need: In Vermont, the growing elderly population, coupled with a lack of a decentralized home-based system of care management, posed significant challenges for Vermonters who wanted to live independently at home.
- Intervention: SASH® (Support And Services at Home) helps Vermont's seniors and individuals with disabilities live at home while receiving the care they need.
- Results: SASH participants have experienced fewer falls, reduced uncontrolled hypertension, reduced growth in Medicare expenditures, increased rates of immunizations, and a 40% increase in advance directives, which saves millions of dollars annually.
The ability to live independently, safely, and in good health is important in a rural state like Vermont – its roughly 626,000 residents are spread across more than 9,000 square miles, and Burlington, its largest city, has fewer than 45,000 residents. An innovative initiative in Vermont works to give seniors and individuals with disabilities the option to live independently but still receive care and services.
SASH (Support And Services at Home) uses the existing network of affordable housing organizations to help participants connect with community-based support services and to provide evidence-based health promotion programs, care coordination, and health coaching on site. By using affordable housing hub sites across the state, the SASH model is able to provide a comprehensive and consistent platform for care and support where people live.
Through a SASH Collaboration Agreement, organizations across the state formally come together to work with participants to address their challenges to remaining healthy at home. Cathedral Square Corporation manages SASH at the state level, while six Designated Regional Housing Organizations (DRHOs) work at a regional level.
SASH is funded by the following:
- Cathedral Square Corporation
- Centers for Medicare and Medicaid Services (CMS)
- Champlain Investment Partners
- Department of Vermont Health Access (DVHA)
- Enterprise Community Partners
- Housing Assistance Council
- MacArthur Foundation
- Multi-Payer Advanced Primary Care Practice (MAPCP)
- People's United Community Foundation
- University of Vermont Medical Center Foundation
- UVM Center on Aging
- Vermont Community Foundation
- Vermont Department of Disabilities, Aging and Independent Living (DAIL)
- Vermont Department of Health
- Vermont Housing and Conservation Board (VHCB)
- Vermont Legislature
The SASH program is available in all corners of Vermont, and the scattered-site, decentralized nature of the delivery system allows residents to access benefits in the most isolated and rural parts of the state. Vermont residents or their family members can make referrals by clicking on the resident's county in the SASH Statewide Location Map and completing the referral form.
SASH participants work with a housing-based care coordinator (also called a community health worker) and a wellness nurse to determine their health and wellness goals. For rural residents living on their own, SASH staff will visit them in their homes to complete a health assessment and develop action plans.
SASH staff are also located at affordable housing properties in every county and serve the residents in the buildings as well as Medicare beneficiaries in the surrounding area. These staff make regular home visits to discuss participants' goals and progress, make risk assessments, and alert service providers to any issues such as prescriptions that need to be refilled.
In addition, the SASH staff provides assistance with any of the following:
- Check-ins and health coaching
- Comprehensive health and wellness assessment
- Individualized Healthy Living Plan
- Medication management assistance
- Planning for successful transitions from hospitals or nursing homes
Patients' costs are completely covered by partner housing agencies, a Medicare demonstration, and grants; the patients pay no money for using SASH services. SASH serves residents in subsidized housing communities and all Medicare beneficiaries regardless of age, income, or residential setting.
To learn more about the SASH program, please watch this 2-minute video:
SASH works out of 22 nonprofit housing organizations and works with over 5,000 Vermonters, most of whom are rural, except for those living in the greater Chittenden County area. Since its pilot program in 2009 and expansion in 2011, patients have experienced:
- Fewer falls
- Reduced uncontrolled hypertension
- Reduced growth of Medicare expenditures ($128 per-beneficiary-per-month)
- Increased rates of immunizations
- 40% increase in advance directives, which saves millions of dollars annually
In January 2016, $15 million in federal funding was made available for SASH-like models to be replicated and studied in subsidized housing across the country.SASH was featured in a 2017 National Academies of Sciences, Engineering, and Medicine publication called Developing Affordable and Accessible Community-Based Housing for Vulnerable Adults.
Initially, some parties were concerned that the SASH program would cause community partners' responsibilities to overlap or be duplicated. These concerns diminished as roles and responsibilities were more clearly defined and regular interagency team meetings were established.
One of the most pressing barriers to maintaining good health and well-being for SASH participants in rural areas is the lack of public transportation. The SASH staff work tirelessly to connect their rural participants with ride-share opportunities and work with local special services transmit providers to establish weekly routes.
SASH works because it uses the existing affordable housing, aging, primary care, and mental health agency infrastructure already available across the state. While the quantity of these service providers are scarcer in rural areas, the addition of affordable housing-based services that reach out beyond the confines of the building help to connect and stretch the benefits of these existing services.
Aging and aging-related services
Community health workers
Home and community-based services
People with disabilities
November 14, 2016
Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.