Support and Services at Home

Vermont

Support and Services at Home (SASH) coordinates the resources of social service agencies, community health providers and nonprofit housing organizations to help elderly Vermonters and individuals with disabilities live independently at home. Care coordinators and wellness nurses work closely with participants to develop individualized healthy living plans that address unmet medical and social needs, in addition to personal goals. SASH staff also provide wellness check-ins, health coaching for chronic conditions, assistance with medication management, care transitions, help scheduling medical appointments and completing advance directives. Information gathered from participants is pooled to identify common community-wide health issues and inform the planning of evidence-based workshops and community activities. As of 2018, SASH served approximately 5,000 people in the state of Vermont.

Partner Organizations

• Affordable housing providers, home health agencies and area agencies on aging and local hospitals
• Cathedral Square Corporation (founder and affordable housing provider)

Target Population

Older adults and people with disabilities enrolled in Medicare

Care Team

Full-time care coordinator, part-time wellness nurse, social service and community health providers

Timeframe

2009 - present

Results/ Studies

Support and Services at Home (SASH) Evaluation: Evaluation of the First Four Years (2017)

Funding

Federal, state and private grants 

Resources

Program website

Program overview from Community Catalyst (2018)