OpEd: Vermont’s proven model for aging in place
by Liz Genge, SASH Director
It's campaign season, and health care costs are on everyone's mind. Candidates are offering ideas for improving the system, and one solution is already making a difference. As Rustam Sengupta noted in a VT Digger commentary earlier this year, Vermont is facing a growing care crisis. He's right that what many older Vermonters need most isn't more medical care. They need someone who notices when something has changed, and helps them access the support they need to stay healthy and independent at home. Someone who notices when the mail has not been picked up in three days or figures out how to get them to a doctor’s appointment when there is no car and no family nearby. Someone who shows up consistently and builds enough trust that a person will actually ask for help.
That is what SASH coordinators and wellness nurses do, every day, across Vermont.
SASH® (Support and Services at Home) is a Vermont-built program that embeds wellness nurses and coordinators directly in homes in local communities, reaching more than 5,000 older adults and people with disabilities statewide. SASH coordinators are Community Health Workers, the same front-line workforce the state has identified as essential to closing gaps between the health care system and the people it is meant to serve. SASH is infrastructure that is ready to build upon to grow and strengthen Vermont's existing aging-in-place system.
Kristin Bolton, Executive Director of Project Independence and Adult Day, put it plainly in a recent conversation marking SASH's 15th anniversary. When asked what Addison County would be missing if SASH wasn’t there, Bolton replied, "I think we'd be missing a tremendous amount of support that makes growing older easier. Caregivers rely on these multiple layers of community partnerships. Without them, there would be many more stressed families, whether they lived nearby or far away." Life is genuinely easier because of SASH, she said. People may not realize that until they encounter the obstacles that would exist if those connections and handoffs weren't there.
SASH has proven to be a program that is significantly improving and increasing older Vermonters' lives at a low cost. A peer-reviewed study published earlier this year in Health Services Research found that SASH participants gained more than a year of healthy life compared to similar Vermonters not enrolled in the program, with meaningfully lower rates of stroke, heart attack, heart failure, hospital admissions, and emergency department visits. Only 16 percent transitioned to long-term care, far below what researchers expected.
The cost of achieving those outcomes is between $4,000 and $8,000 per quality-adjusted life year (QALY). That is a fraction of the $100,000 per QALY threshold widely used in the U.S. to evaluate whether a health intervention provides good value.
Sengupta is right that Vermont's care crisis calls for community-powered, nonmedical care networks. Cathedral Square has been running one for fifteen years. Helping people stay independent and at home is at the heart of our mission, and Vermont already knows how to do it. Our job now is to make sure the state keeps investing in what already works and expanding it to ensure all Vermonters have access.