By Geralyn Magan
A new report summarizes the findings of an evaluation of the Support and Services at Home (SASH) program conducted between 2010 to 2016 by RTI International and the LTSS Center.
The Office of the Assistant Secretary for Planning and Evaluation at the U.S. Department of Health and Human Services (HHS) recently released the findings of an evaluation of the Support and Services at Home (SASH) program. The evaluation was conducted between 2010 and 2016 by researchers at RTI International and the LeadingAge LTSS Center @UMass Boston (formerly the Center for Applied Research).
HHS released a full report of the evaluation’s findings and a shorter report that includes highlights from the evaluation.
ABOUT SASH
The Cathedral Square Corporation (CSC), a LeadingAge member in Vermont, developed SASH to connect older adults and individuals with disabilities, living in affordable housing properties or the surrounding communities, with support services and community-based health care services. The goal of the program was to promote greater care coordination, improve health status, and slow the growth of health care expenditures.
SASH was delivered to panels of approximately 100 participants. Each panel is served by a full-time SASH coordinator and a quarter-time wellness nurse. In 2016, most of the 54 SASH panels were hosted by nonprofit housing organizations and located in federally subsidized or other nonprofit affordable housing properties.
At the regional level, 6 Designated Regional Housing Organizations (DRHOs) are responsible for planning the rollout and supporting implementation of the SASH program across their geographic regions. Cathedral Square Corporation serves as one of these 6 six DRHOs. A significant portion of the Cathedral Square’s DRHO panels (CSC DRHO) are located in urban areas.
KEY FINDINGS
Researchers conducted their evaluation of the SASH program using Medicare and Medicaid claims data, data collected from interviews with SASH staff and key stakeholders, and a mail survey of Medicare beneficiaries. Their quantitative analysis compared the health outcomes and service utilization of SASH participants with those of Medicare beneficiaries living in HUD-assisted properties not participating in SASH.
Their principal findings include:
Slower growth in Medicare expenditures: Medicare claims data showed that growth in annual Medicare expenditures was slower by an estimated $1,100 per beneficiary per year among the site-based SASH participants in the CSC DRHO panels. Participants in urban panels saw slower growth in Medicare expenditures of over $1,450 per beneficiary per year. SASH participants in the urban panels also had slower rates of growth for hospital, emergency department, and specialty physician costs. However, there was no evidence that the SASH program decreased Medicare expenditures for panel participants in the other 5 DRHOs.
Dual eligibles: The slower growth in Medicare expenditures among the CSC DRHO panels and the other urban panels was driven by slower growth in Medicare expenditures for panel participants who were dually eligible for Medicare and Medicaid. About 45% of the participants in the CSC DRHO panels and the other urban panels were dually-eligible.
Hospital admissions: Analysis of Medicare claims data indicated that SASH participants in the urban panels had significantly lower rates of all-cause hospital admissions compared to non-participants.
Medicaid expenditures: Among dually eligible SASH participants, growth in Medicaid expenditures for institutional long-term care was significantly slower for participants in site-based panels and rural panels. The average impact was $400 per participant per year.
Injuries: The SASH program had a favorable impact on the incidence of injuries leading to an emergency department visit or hospitalization among SASH participants over the age of 65. These injuries were often associated with falls.
SUCCESSES AND CHALLENGES
The research team identified several factors that affect the success of housing plus services programs, or present implementation challenges. These factors include:
- Availability of staff time and other resources: Site visit interviewees emphasized the limited number of wellness nurse hours as one of the primary challenges in the SASH program across all the SASH panels. The greater travel time in rural areas and in panels with a large proportion of community participants reduced the amount of time wellness nurses could spend with SASH participants. “Increasing the wellness nurse hours could result in a larger impact on participants,” write the researchers.
- Population differences: The SASH program may have more favorable impacts on health care costs among panels with a larger proportion of older adults, compared with panels consisting of younger participants with disabilities. In addition, the expansion of the SASH program beyond the housing sites and into the community presented many challenges because community-dwelling SASH participants tended to be older and in poorer health, relative to the site-based participants. “Future housing-with-services programs seeking to serve a widely dispersed population in the community should be aware that the needs of the community participants could require additional resources,” write the authors of the report.
- Education and communication: Robust training programs ensure that staff maintain the necessary knowledge and skills to best serve SASH participants. In addition, an effort to build relationships and foster greater collaboration across community organizations can help connect SASH participants to a variety of needed services and resources. “Other entities seeking to implement SASH-like programs should plan to spend time educating partner agencies and clearly delineating roles and responsibilities across organizations and programs, to avoid any real or perceived duplication of services and to foster good relationships,” the researchers conclude.