Support And Services at Home (SASH) coordinates the resources of social service agencies, community health providers and nonprofit housing organizations to support Vermonters who choose to live independently at home. Individualized, on-site support is provided by a Wellness Nurse and a trained SASH Care Coordinator.

At its core, SASH is really about the everyday interactions, actions, planning and brainstorming ideas between members of the SASH team (which includes the SASH participant) that creates a seamless system of care that has shown significant positive outcomes for individuals’ ability to remain at home.

SASH serves seniors and individuals with special needs who receive Medicare support and who live in congregate housing – or the surrounding community. Today, SASH touches the lives of approximately 5,000 people across the state of Vermont. (Read the SASH Notice of Privacy Practices here.)

The SASH Pilot Program

The State of Vermont is one of eight states awarded an Innovation Demonstration Program from the Center of Medicare and Medicaid Services in order to fund staffing for the SASH Program.  2014 marked the third year of the three-year demonstration with over 3,000 participants in Vermont’s SASH programs.

Downstreet is one of six Designated Regional Housing Organizations throughout the state implementing the SASH Program. SASH is designed to bring care management and preventative services right to where people live and allows for an organized, person centered approach to wellness in our communities. In order to do this, Downstreet provides SASH services at three area senior centers, as well as our properties in Cabot, Waterbury and Waitsfield.

The SASH Pilot Program yielded results that exceeded expectations, including:


Two of Downstreet’s SASH participants take part in the “Silver Sneakers” walking program in Waitsfield, VT.

Statewide Falls
(3 or more reported in the past year)

2012 39%
2013 29%

Statewide High Nutritional Risk

2012 35%
2013 24%

Reduction in Hospitalizations

Reduction in Falls Statewide

Reduction in Nutritional Risk

Quarterly Savings in Dollars

  • Quarterly savings reached $422 per beneficiary per month (estimate indicated by the Medicare expenditure trend model)

  • Reduction in hospitalizations

  • Reduced falls statewide

  • Reduced statewide nutritional risk

  • No bounce backs to Hospital/SNF

  • Increased physical activity

Meet Downstreet SASH Coordinators Kenneth Russell and Jennifer LaPan.


The SASH team includes the individual participating in the SASH model, the community-embedded SASH Care Manager and SASH Wellness Nurse working out of a non-profit or public housing owned or managed housing, a designated case manager from the local area agency on aging, a skilled home-care nurse from a local home health agency, a mental health and/or developmental services employee from the community mental health agency, and other representative(s) from local agencies as appropriate for the needs of the population being served.

SASH Support Services Include:

  • A comprehensive health and wellness assessment
  • An individualized Healthy Living Plan
  • Check-ins and coaching
  • Convenient access to a wellness nurse
  • Transitions support after hospital, nursing home or short-term rehab stay
  • A trusted guide to help navigate the health care system
  • An informed team to help in crisis
  • Access to prevention and wellness programs


Downstreet works with many partners to ensure the success of the SASH program. Here are some of the organizations with which we work: