City, state effort to keep elderly healthy could go national

VERGENNES — The organizers of a year-old program based in Vergennes that is intended to help seniors stay healthy and independent say it is working well as they plan to expand the effort to other Addison County sites, including Middlebury, Bristol, Shoreham and Orwell.
The program is called “SASH,” short for Support and Services at Home. It is being coordinated from the year-old Armory Lane senior housing center by the Addison County Community Trust (ACCT), and its roughly $65,000 annual budget is being funded by a federal grant in hopes that keeping seniors healthier will also cut Medicare costs.
ACCT head Terry McKnight said that goal is being met, although data are just now being collected for what is a program that is unique to Vermont and has sites in each county.
“They’ve been working on SASH in Vermont for about two years now. So all of the statistics have been going in,” McKnight said. “It appears that SASH is making a difference, that the results are better where you have SASH … operating where people live.”
Twenty-five of the 62 Vergennes-area SASH clients live in the Armory Lane senior housing center. That’s where SASH coordinator Nina Welsh spends most of her time, where the program funds a registered nurse to work 10 hours a week, and where Welsh said SASH has made a difference.
“We’re seeing a difference already at Armory Lane,” Welsh said. “Even when we started a year ago there were a lot more ER visits … I’ll bet you they’re cut in half.”
The key to SASH is the extra personal attention that seniors who are living on their own get from SASH personnel in preventing and managing disease and accidents through wellness and education programs, and through follow-up after accidents and hospital stays to make sure clients are doing the right things to take care of themselves.
“We complement and we fill in the gaps,” Welsh said. “I’m just amazed all the time at the things people need that aren’t covered under any particular program.”  
For example, McKnight said if a senior is living alone without regular support, much can go wrong after a hospital stay. SASH can cut down on re-admittance, helping clients’ well-being and Medicare’s bottom line.
“People come home and they forget to take their meds, so they take them all at once because they figure they have to catch up. And they have an incident that takes them back to the hospital,” McKnight said.
SASH oversight can also prevent or shorten hospital stays, McKnight and Welsh said. Welsh recalled one case at the Armory Lane center when a client didn’t show up to a movie, and she quickly learned he had stomach cramps and was able to contact his family and get him medical attention.
Another time, Welsh said a resident felt chest pain, but didn’t want to call a doctor. Welsh called in the nurse to convince him to get to the hospital immediately, possibly avoiding a heart attack. Welsh also works with those who have chronic conditions and has helped a diabetes patient go shopping for healthy food.
SASH also partners with groups like Champlain Valley Agency on Aging, the Counseling Service of Addison County and Porter Hospital to coordinate wellness programming, including presentations on nutrition and fall prevention and fitness classes, such as tai chi.
“Wellness activities, tai chi, exercise, even in your wheel chair, (and) … nutrition planning, not overeating, not eating junk, all of these things will improve health,” McKnight said, adding, “We have a lot of assistance. This whole SASH concept is one big memorandum of understanding … We can use their resources. We don’t try to duplicate what they’re doing. We simply try to make this extended outreach to people on Medicare.”
Most of those programs are held on Armory Lane, but as SASH expands, notably to nearby housing developments in Vergennes that cater to seniors on Walker Avenue, they will be offered there, he said.
Many of the recent SASH recruits have come from that area. Welsh explained the sales pitch.
“There’s the chronic-disease self-management. There’s the wellness management, and there’s the care coordination part if they happen to go to the hospital or rehab,” Welsh said. “It really offers them a lot. It’s a free program.”
McKnight said they hope to expand the Vergennes SASH to 100 clients, a total that will also be the goal in Middlebury later this year and Bristol in 2014. The target in the Shoreham-Orwell area will be about 50; McKnight notes their research shows about 30 women between the ages of 65 and 91 living alone in Orwell homes.
Reaching seniors in rural areas without senior housing will pose more of a challenge, although they hope eventually there can be two-dozen units between Shoreham and Orwell. Transportation volunteers could also play a critical role, they said.
“Somehow we have to connect them in with programs like this, make it possible for them to become part of the community in a sense. And that’s a transportation problem … And where can we find a place that is convenient enough to bring people together. But we can bring programs to them,” McKnight said. “Some of them have computers … We can talk to them. We can visit them. But it’s more difficult.”
But the potential rewards are great — and not only for the seniors, and possibly not only for Vermont, McKnight said.
SASH is part of the Vermont Blueprint for Health that is tied into the federal Affordable Care Act (ACA). The ACA requires states to look at ways to improve wellness as a method to reduce medical costs, or at least slow their growth. Vermont, McKnight said, is the only state to tie SASH programs in with the Blueprint as a way to trim Medicare spending.
If the numbers are as good as SASH backers expect, the template could go national.
“We’re hopeful it will get around the nation, because it works,” McKnight said.  
On the other hand, the $10 million federal grant through the Center for Medicare and Medicaid Services that funds SASH programming will expire next year. McKnight hopes at the least SASH will have proven its worth locally, and centers like that on Armory Lane will find a way to keep it up and running.
“Then the question is how can we, in a sense, maintain the same program?” he said. “Where can we find that money?”
McKnight is optimistic that won’t be necessary.
“My thought is that if the statistics are good, we’re going to see support of it here, and extension of it,” he said. “We’re going to see people coming here to see what we’re doing in Vermont.”
Andy Kirkaldy may be reached at [email protected].

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