what is sash? a caring partnership brought together to help people remain in their homes. the...
Post on 31-Dec-2015
218 Views
Preview:
TRANSCRIPT
What is SASH?
A caring partnership brought together to help people remain in their homes.
The partnership connects the health and long-term care systems to nonprofit affordable housing providers.
Profile of Heineberg Residents
85% over 70; 40% over 8549% used ER in past year54% take 6 or more prescription meds71% have high blood pressure, 59% arthritis,
39% chronic pain.61% fallen in past year32% self-reported mental health concerns59% use a cane or walker49% failed 2-3 components of a cognitive
screen
Results at Heineberg
• 19% reduction in hospitalizations
• No bounce backs from Nursing Homes
• Reduced falls- 22%• Increased physical activity• Reduced nutritional risk-
26% reduction
Better health, better care & lower costs
Implementing SASH in your state
Build partnerships
Written Agreements (not “lip service”)
Need Leadership from the State
Tell the Story!
The SASH Alliance
Government Entities• Division of Health Care Reform• Department of Aging• Department of Public Health• Medicaid Division• Legislature
Non Profit Business Sector• Housing: Non Profit and PHAs• Hospitals• Medical Homes• Home Health• PACE• AAA’s• Community Mental Health
Agencies
Philanthropic Leaders• Vermont Health Foundation• McArthur Foundation• Enterprise Community Partners• People’s United Bank
Foundation• United Way
Academic Experts• University of Vermont, Center
on Aging – Geriatric Fellows• Albany College of Pharmacy• Castleton School of Nursing
Other• AARP
Regional Collaborative Agreements
Mental Health
University
Funder
AAAPACE
Hospital
Housing
Home Health
SUCCESS FACTORS
Connecting HOME to the Medical Home An MOU with all the partners Breaking the Information Barrier Population based and targeted Ability to measure outcomes Outcomes: Cost savings, health, satisfaction The Team: non duplication and mutual aid Person Centered Care Management Prevention and Wellness Workforce: highest and best use
•
Lessons Learned • Ask for input- again and again
• Fear of Change
• Anticipating Cross Sector Opportunities
• Patience Pays Off
• Leadership- state and local
What are the Essential Elements?
Person-centered – Population based
SASH Staff Team Based Care ManagementInformation Sharing through Technology
Prevention and Wellness through Healthy Living Planning
Volunteers
Information Sharing
Housing Staff
Community Providers
(VNA, AAA, Mental Health)
Community Health Team
Hospital
Family Support Persons
Primary Care Provider
Nursing Homes/Rehab
Facilities
What Does SASH Provide?
Comprehensive AssessmentPerson Centered Healthy Aging PlanningInformed Team to Help in a CrisisTransitions Support back HomeProven Practices through the CHAPRegular Check InsCoachingWellness Nurse SupportsLink with CHT and Medical Home
Statewide Rollout$700 per enrollee per
year Supports SASH
Coordinators and Wellness Nurses
6,120 enrollees over 3 years
112 SASH hubs
top related