Vermont Home Care Initiative is Model for Other States

Support and Services at Home (SASH) in Vermont has become a model for home-based health—the program is expanding into two states and has been used as inspiration for a federally funded test pilot.

SASH—which was the focus of a U.S. News & World Report article published Thursday—integrates housing, health care and social services. The program seeks to help older adults save money through preventive health care and delay institutional care. SASH was piloted by housing nonprofit Cathedral Square in 2009 and launched to the public in 2011, according to the organization. SASH serves 5,000 people throughout Vermont.

“I see this as a changing the paradigm of how health care and supportive services are delivered,” Molly Dugan, SASH director, told U.S. News. “We know things about them that their doctors don’t know, that other community providers don’t know, because we see them day in and day out.”


Most SASH participants live in 138 affordable housing sites, although 10% to 20% live in mobile homes, single-family homes or other apartments, Dugan said. The program is funded partially by Centers for Medicare and Medicaid Services (CMS) through Vermont’s all-payer Accountable Care Organization Model and receives support from state and charitable organizations. SASH program leaders report that securing sustainable funding is a challenge—for SASH and programs like it.

Advocates report that efforts toward in-home elderly care are moving in the right direction.

National Well Home Network launched in June 2017 to expand the model to other states. The first expansions will be to Rhode Island and Minnesota.


“I’m working to get this to scale in urban areas with the hopes that we can achieve so much savings there,” Nancy Eldridge, executive director at National Well Home Network and former Cathedral Square CEO, told U.S. News & World Report. “Most urban areas in this country have a higher volume of low-income seniors, and more density, which is so (different than) staff driving around the Northeast Kingdom of Vermont. It just saves time.”

Other efforts, similar to SASH, are in a testing phase across California, Illinois, Maryland, Massachusetts, Michigan, New Jersey and South Carolina.

The federal Department of Housing and Urban Development awarded $15 million in grants to 40 affordable senior housing developments to seven states to pilot a trail based on SASH that is slated to finish in 2020, according to a press release from HUD.

Written by Kaitlyn Mattson

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