Vermont SASH

Housing and Services: Vermont’s SASH Program is a Model for Senior Care

On September 2, Cathedral Square Corporation hosted a peer exchange on the Vermont pilot program SASH (Support and Services at Home). This exchange was supported by the Housing Assistance Council, US Department of Housing and Urban Development, The People’s United Bank Foundation, and The Atlantic Philanthropies. The following is a story relayed at the meeting by John Broderick of the Regional Affordable Housing Coalition in Vermont.

A resident of an independent housing community became violent and combative. The actions were not in character for this resident. Staff knew something was wrong and went into emergency mode. They sought medical assistance for him and then held a meeting with the other residents in the facility.

At the meeting, the housing staff emphasized that they were not going to evict this resident. They decided to do everything in their power to find out what was wrong and fix it. Staff explained that upon his recovery, the resident would be welcomed back to the housing. All residents were assured that if something like this happened to them, they would always have the backing of the housing staff. The residents supported this plan for multiple reasons: 1) they had formed a relationship with their neighbor and cared about his well being, and 2) they knew that this could happen to them and appreciated the housing staff’s position. “It’s important to know that you have a home to return to when you recover from a health incident.”

So what happened? It turned out that a change in the resident’s medication was causing the emotional breakdown. Once the medication was returned to its original dosage he was fine and had a home to come back to. This was a relief for the housing staff as well as residents.

This story is relevant to senior housing developers because it is an example of how important services are to providing a safe and affordable living environment. Often housing staff are the first to notice if a resident is not him or herself. They can support their residents by recommending doctor visits or investigating their well being. In this particular story, the houser attempted to talk with the resident’s physician, but the doctor could not disclose critical information. With SASH, a resident can authorize their housing provider to work with their physician, in their best interests. The SASH program model supports this kind of activity.

What is SASH?

Part of the Vermont Blueprint for Health, SASH is a demonstration program funded by Medicare under the Centers for Medicare and Medicaid Services, part of the US Department of Health and Human Services. Vermont’s SASH (Support and Services at Home) is critical for serving seniors; it fills both non-medical and social needs of residents in their homes and has a direct impact on housing conditions for seniors. Over a three year period SASH will serve 6,120 Medicare recipients both in their own homes, as well as in affordable rental housing. SASH brings an underutilized asset into the long-term care system: affordable housing providers -- the providers include, Community Housing Development Organizations (CHDOs), public housing authorities, and nonprofit housing providers. These Organizations offer three advantages. They:

  1. provide housing in a common setting to the lowest income Vermonters, who because of age and poverty have a high incidence of chronic conditions and health care usage;
  2. work from a number of settings scattered throughout the state, providing community-based sites for service hubs embedded in the community; and
  3. have significant assets to be leveraged in the form of staff, information, and infrastructure.

For these reasons, housing providers can increase the efficiency and reach of the healthcare system into communities, and assist in achieving the goals of healthcare reform – better health, better care, and lower costs. Housing development and repair programs cannot pay for services to seniors. SASH may be the best source of funding to provide supportive services in senior housing projects in Vermont on a sustainable basis.

The Role of Housing Providers in SASH

The SASH program allows for an organized, person-centered approach to wellness in the housing community. SASH staff are the eyes and ears on the ground, building trusting relationships with participants and their family members/support persons. Staff, such as a SASH Coordinator embedded at the facility and a Wellness Nurse, are “trusted guides” and integral to the success of the model. They focus their efforts around three types of interventions: transitions support, self-management education, and care coordination. These staff are a resource not just for residents, but for family members and community service providers as well. The SASH Coordinator is the point person at the housing site.

SASH will be expanded to 112 housing sites in Vermont, beginning October 3. Each site will enroll a panel of 50-100 voluntary SASH participants. Each full panel is staffed by one full-time SASH Coordinator and a quarter-time Wellness Nurse. The staff form teams with the existing long-term care network and include a designated nurse from the Visiting Nurse Association, a designated case manager from the Area Agency on Aging, a representative of PACE (Program of All- Inclusive Care for the Elderly), and a representative from the community mental health agency. The teams participate in a multi-week training program strengthening technical and team building skills, and sharing knowledge. Once trained, they meet twice a month to review the well-being of Medicare-eligible SASH participants. (NOTE: SASH is not just for the elderly)

Implementing SASH - Technology Changes

Health information technology will be used to unify information and create communication between all service providers. Fragmentation of care “should be a never event.” The SASH implementation team is creating the infrastructure necessary to support the system as it develops by focusing on the end users, the seniors participating in the program.

The Vermont state government is funding a new database that will integrate all systems necessary for implementing SASH. The database will include directories for information exchange and community health as well as a provider directory, and a master persons index of the participants in the program.

SASH Resources

As part of its implementation of the program, Cathedral Square Corporation is developing a SASH manual, which will have modules on a variety of SASH topics. This manual will include assessment forms, recommendations for programs, and checklists. Also within the manual will be designs for accessible senior housing facilities. The manual will be distributed to SASH facilities on flash drives with the ability to revise documents as staff implement the program. It will be a living document, revised as necessary throughout time.

Examples from the design module include sharable layouts for a one-bedroom 600-square-foot apartment and ideas for a number of design elements, including a communication center, business center, hand rails, resting centers, and scooter and shopping cart parking. The manual encourages the development team for affordable senior housing to think about accessibility as well as the services it provides. The bottom line is, “How are people going to be safe and secure?”

~Panelists at this exchange included Merten Bangemann-Johnson, Gilman Housing Trust; John Broderick, Regional Affordable Housing Coalition; Eileen Peltier, Central Vermont Community Land Trust; Kevin Loso, Rutland Housing Authority; Hunt Blair, Department of Vermont Health Access; Craig Jones, Blueprint for Health, State of Vermont; and Nancy Eldridge, Molly Dugan, Kim Fitzgerald and Amy Wright, Cathedral Square Corporation. For more information about the SASH program view this video produced by Cathedral Square Corporation in Vermont. or visit

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