Author: Deborah Bouton

New Statewide Director and Assistant Director Named for SASH

Cathedral Square has named two women with long-standing experience in the Support and Services at Home (SASH®) program to the top leadership posts of the statewide program.

Liz Genge of Montpelier (photo, left) is the new director, and Casey Doerner RN of East Ryegate (photo, right) is the new assistant director. They will oversee SASH teams throughout Vermont that provide support and coordinate personalized care and programming for the approximately 5,000 Medicare recipients enrolled in the program.

Genge comes to SASH with 20 years’ experience at Downstreet Housing & Community Development in Barre, where she has served as director of property management since 2011. She was an early champion of SASH who helped launch the program in Washington and Orange counties 10 years ago and has overseen SASH operations in Downstreet’s housing communities since.

Genge says she felt called to the director position of SASH after witnessing the benefits of its person-centered approach to health and well-being firsthand.

“I was intrigued from the start with this innovative way to deliver services to individuals right at home while also strengthening community collaborations with our partners,” she says. “I still feel that excitement and enthusiasm about SASH and am proud to lead SASH teams throughout Vermont in building on the program’s many successes.”

Doerner, a licensed registered nurse, has been affiliated with SASH since 2015, starting as a SASH wellness nurse for RuralEdge Community Development, where she worked with SASH participants in eastern Orange County. In 2019, she joined Cathedral Square as the SASH health systems educator and wellness nurse lead, working with SASH programs throughout the state. Throughout the COVID-19 pandemic, Doerner has played a lead role in developing Cathedral Square’s procedures to mitigate the coronavirus, which have been viewed as a model by public health officials.

“I am so honored to step into the very big shoes of the amazing people who have built and led the SASH program all these years,” says Doerner. “I am excited to help lead SASH as we continue the vital work of keeping people in their homes –safe, healthy and connected.”

Cathedral Square CEO Kim Fitzgerald says she couldn’t be happier that Genge and Doerner will be leading SASH into the future.

“We are always pleased when we can promote strong, qualified staff, and Casey Doerner amplifies that definition,” she says. “Casey has done a fantastic job teaching and leading SASH wellness nurses and coordinators throughout the pandemic and made us all proud. She will be an excellent assistant director.”

The role of SASH director is a challenging position to fill because it encompasses so many responsibilities, Fitzgerald says, “so we really have hit the jackpot with Liz. We are so fortunate to have someone of her caliber who has been engaged in SASH from the beginning and has a deep passion for the vision of SASH.” Genge also brings a wealth of expertise in property and staff management, Fitzgerald adds.

SASH is a nationally recognized, award-winning program of care coordination and prevention created by Cathedral Square and implemented statewide in 2011 in partnership with Vermont Area Agencies on Aging, member affiliates of Vermont Care Partners and the VNAs of Vermont, nonprofit housing organizations, primary and community health care teams, and local and regional hospitals. It is available free of charge to Vermonters on Medicare living in affordable housing and surrounding communities. SASH has been documented to improve health, save Medicare and Medicaid dollars, and help people “age in place” at home. For more information, visit sashvt.org.

Forbes Magazine Highlights SASH as a Way to Reduce Medical Costs for Older Adults

An article by latest federal evaluation showing significant savings in Medicare/Medicaid costs, as well as happier, healthier people. SASH is “an important example of the potential advantages of pairing senior housing with services. It can help older adults stay at home longer, and may keep them out of the hospital and reduce Medicare costs,” Gleckman concludes.  Read the article here.

Federal Study Links SASH to Medicaid Savings for Long-Term Care

A new federal evaluation of Vermont’s groundbreaking “Support and Services at Home” (SASH) program, released July 12, 2019, shows significantly slower growth in the cost of long-term institutional care for very low-income SASH participants compared to non-participants. The finding holds true for SASH participants age 65 and older who receive Medicaid to cover the cost of long-term care in nursing homes. Medicaid costs were about $400 less per beneficiary per year among participants living at affordable-housing sites where SASH is based, researchers found.  Learn More.

New Study Links SASH to Medicaid Savings for Long-Term Care

The latest federal evaluation of Vermont’s groundbreaking “Support and Services at Home” (SASH) program, released July 12, 2019, hows significantly slower growth in the cost of long-term institutional care for very low-income SASH participants living in most areas of the state compared to non-participants.

The finding holds true for SASH participants age 65 and older who receive Medicaid to cover the cost of long-term care in nursing homes. Medicaid costs were about $400 less per beneficiary per year among participants living at affordable-housing sites where SASH is based, researchers found.

Vermont has a strong record of preventing and delaying nursing home care. For  more than a decade, home health agencies, area agencies on aging and adult day centers have helped hundreds of Vermonters stay living at home through a Medicaid–funded program called Choices for Care. This study shows that even in a state with a strong commitment to the independence of older Vermonters, the SASH model makes a difference.

“This is a significant finding because it shows that SASH delays or prevents nursing-home placement,” said Amy Kandilov, lead investigator of the study, which was conducted for the U.S. Department of Health & Human Services by RTI International and the LeadingAge Center for Applied Research. “It’s also one of the few programs we have evaluated that is having a favorable impact on both Medicare and Medicaid expenditures for the population served.”

Previous independent evaluations of SASH have documented savings in Medicare expenses for SASH participants, but this is the first time researchers honed in on SASH as it relates to Medicaid costs.

Most SASH participants live in congregate affordable housing. They are supported by a statewide network of social-service agencies and health-care partners, including nonprofit housing organizations, area agencies on aging, community mental health centers, home health agencies, primary and community care teams, and regional hospitals. Participants receive individualized support at home from a SASH care coordinator and a wellness nurse, who together with these partners help about 5,000 SASH participants live safely at home and avoid costly medical interventions. The program is free to participants, with funding provided by OneCare Vermont and the state of Vermont.

The authors of the study, “SASH Evaluation Findings, 2010-2016,” analyzed Medicare and Medicaid claims from 2011 to 2016 and surveyed participants and stakeholders to evaluate the impact exclusively of SASH on health status and well-being. They examined data for 54 Vermont panels (groups of approximately 100 SASH participants each) and 116 affordable-housing communities that host SASH.

Researchers also confirmed that Medicare costs continue to be lower for SASH participants, especially those in urban areas ($1,450 less per beneficiary per year). The positive impact of SASH on total Medicare expenditures was driven by “statistically significant slower growth in Medicare expenditures for hospital stays, emergency room visits, and specialist physicians, which is consistent with the SASH program goal of preventing unnecessary high-cost care,” Kandilov added.

Researchers also affirmed earlier findings that SASH participants report greater ease managing their medications and, at housing sites where SASH is based, that property managers credit SASH for diffusing tenant disputes and helping residents avoid eviction due to mental health and other challenges.

Robyn Stone DrPH, senior vice president for research at LeadingAge LTSS Center, emphasized the significance of the new study. “These findings should be of particular interest to policymakers at the federal and state levels as well as managed-care plans and other health systems that are responsible for the care of low-income older adults,” she said, adding, “Partnering with affordable senior-housing providers makes sense for payers, providers and consumers, both from a quality and a cost perspective.”

Read highlights and the full study, “SASH Evaluation Findings, 2010-2016.”

SASH Featured in U.S. News & World Report

SASH participant Jeanne Daley is featured in an article in U.S. News about her overall improvement in health and emotional well-being since moving into a residence where SASH is offered. The article dives into the “what” and “how” of the SASH model, speaking specifically to Daley’s successes. The article also touches on the interest of several states to replicate SASH within their borders. Read the full article here.

SASH Shown to Reduce Growth in Costs for Emergency Department and Specialist Visits

A study published in the national HUD research journal Cityscape identifies the traits of SASH groups (“panels”) that have the biggest bang when it comes to reducing Medicare expenditures. Among the findings: Visits to emergency rooms and specialty physicians by SASH participants in nearly all Vermont SASH panels cost less compared to the control group, with statistically significant savings among participants in the early and urban panels who are eligible for both Medicare and Medicaid. The study, conducted by RTI, was a deeper analysis of data RTI gathered during its most recent evaluation of SASH. Read the study here.

SASH Innovation Featured by National Organization

St. Johnsbury SASH participant Regina Fournier’s story is featured in an issue brief published by the Center for Consumer Engagement in Health Innovation as part of its series on highly effective programs serving older adults and people with disabilities. The brief itself discusses the huge success of SASH since its start in 2009. The overview walks through how the SASH program operates, showcasing why SASH was chosen as one of the most innovative programs supporting older adults and differently abled persons. Read the full brief here