ST. ALBANS — Shirley Nolan, 73, enjoys living in Four Winds, subsidized elderly housing operated by Cathedral Square. One of the things she likes most is the support she receives to remain independent.

“They help us to stay healthy and exercise and eat healthy,” said Nolan.

Nolan is a participant in Support and Service at Home (SASH), a wellness and support program that is part of the Blueprints for Health. The program provides a variety of supports from exercise classes to wellness visits from nurses and assistance with arranging post-operative care.

Funded by Medicare, the program is completely free for participants. Originally, the brainchild of Cathedral Square head Nancy Eldridge, SASH has expanded to other housing providers and into the community.

Eldridge realized that when elderly tenants arrived back at their apartments after receiving a hip replacement, the housing agency just became involved in health care, said Lise MacDonald, a SASH coordinator at Four Winds.

SASH has expanded to 118 sites and more than 4,000 Vermonters in just a few years, in part because it has been shown to reduce costs. A study of the program by Medicare found that it saved an average of $2,200 per participant annually – or about $8.8 million. The savings come from reduced hospitalization, fewer falls and better nutrition. In the first year of the original pilot at a Cathedral Square elderly housing site in Burlington visits to the emergency room declined 19 percent, said MacDonald.

“We’re the boots on the ground,” said MacDonald. “We see them every day, not 10 minutes every three months.” Because they interact with tenants at Four Winds daily the SASH coordinators can observe their vision, dexterity, mobility and other indicators.

“Because we’re here, the teachable moments are many. We never pass up a teachable moment,” said MacDonald.

After hospitalization

Each participant goes through an initial interview in which the SASH coordinators identify possible needs from inadequate nutrition, to dental work, to hearing loss. They find out about previous occupations, family support and chronic illnesses.

Participants are asked to sign a release allowing their primary care physician, Franklin County Home Health, SASH and other agencies to share information about their care. This makes is possible for SASH coordinators to work with physicians and home health on care plans for those released from the hospital, for example.

“One of the times that people are at greatest risk for being hospitalized is when they’ve just been released,” said MacDonald. Patients return home tired and possibly in pain. Their medications have often been changed.

Because they can communicate with participants’ physicians, SASH coordinators can check in with patients to make certain they have their new medications and other needed care.

For Nolan, who has suffered from bladder cancer, knowing that SASH will be there should she need help is reassuring. “If I wasn’t understanding something I knew they could help,” she said. “I knew I could cry a little and get a hug.”

Nolan’s daughter was able to take her for treatments in Burlington, but if she had needed transportation SASH would have arranged it, Nolan said.

Wellness nurses visit Four Winds three times a week with a blood pressure clinic every Wednesday. The nurses can answer questions from patients, check on their status, and make referrals to primary care. Often those referrals can prevent later visits to the emergency room, according to MacDonald.

There are onsite exercise classes and healthy meals such as the carrot soup served on Wednesday. Exercise is key to reducing falls by preserving strength and mobility, said MacDonald.

They’re also a good time to laugh with friends, according to Nolan.

Continuing help

Four Winds has brought in medical staff to evaluate the mobility and balance of SASH participants and make referrals for physical therapy for those at risk of falling.

MacDonald has offered classes on managing chronic illnesses.

“When I come back from doing things I feel like I’ve accomplished something,” said Nolan, who said she participates in every program SASH offers.

Nutrition is another challenge for the elderly. “They don’t eat three meals a day. They’re eating alone. They’re isolated,” explained MacDonald.

Many SASH participants are no longer able to cook and rely on their microwaves to heat up frozen meals. Others can’t afford to purchase fresh fruits and vegetables. SASH coordinators help participants sign up for Meals on Wheels and 3 Squares Vermont.

They can also help participants get dental care. Untreated dental problems often get in the way of good nutrition, explained MacDonald.

Similar to the need for a dental visit can be the need to have toenails trimmed. Long nails make shoes uncomfortable, so people forego wearing stable shoes, which can lead to falls, said MacDonald.

“It’s little stuff, but when you get enough of the little things it can make a big difference,” said MacDonald.

Elderly Vermonters don’t have to live in one of the housing sites to participate. There are approximately 70 participants in the Four Winds program who don’t reside there. Those participants can take part in any SASH program for free, including exercise classes offered at Heritage Village twice per week, as well as those offered at Four Winds.

SASH coordinators provide the same services to participants living in the community.

In one recent case, a SASH participant called to express concern about a couple that hadn’t been to church recently. A SASH coordinator contacted them, learned the wife was recovering from a fall and arranged for a visit from a wellness nurse. Although the couple thought a wound on the wife’s leg was healing, the nurse referred her for immediate care, potentially saving the infected leg.

Referrals also come from health care providers. The Northern Tier Centers for Health referred a couple because the husband suffered from lymphedema and needed to have his legs wrapped daily, but the wife who usually did the wrapping was scheduled for surgery.

The couple made too much money to qualify for one program, and because they weren’t homebound didn’t qualify for home health visits. A SASH wellness nurse recommended physical therapy and the primary care physician made the referral. The physical therapists were able to find a device that made it possible for the man to wrap his own legs.

“It’s a great example of brainstorming, just simple brainstorming,” said MacDonald.

One of the most powerful aspects of SASH is the cooperation among several agencies, in MacDonald’s view. Members of the SASH team, which includes the coordinators, wellness nurses from Franklin County Home Health, the Champlain Valley Agency on Aging and Northwestern Council and Support Services, meet monthly to discuss participants and how to provide needed services.

“Between the people sitting at the table we can probably come up with a plan to support the person living independently,” said MacDonald.

One of the challenges, however, is that the pay for service model means only the SASH coordinators are getting paid for those meetings. The other agencies are not because no “service” is being provided during the meetings.

Currently, Vermont is the only state that offers SASH, but its continued success is likely to result in Medicare rolling it out to other states. That’s a goal Nolan can get behind. “I don’t think there’s anything that’s been offered to seniors that’s quite like this. I want it to be everywhere,” she said.