SASH Program Vermont: Free Care Coordination for Medicare Seniors

Most families don't hear about SASH until a social worker mentions it offhand during a hospital discharge meeting. That's unfortunate, because Support and Services at Home is one of the strongest preventive care programs in the country — and it costs participants nothing.

What SASH Actually Does

SASH is a team-based care coordination program created by the nonprofit Cathedral Square in 2009. Each SASH panel groups roughly 70 to 100 participants and assigns them a dedicated SASH coordinator and a wellness nurse, typically based in a local affordable housing community but serving seniors across the surrounding area.

The team provides:

• Annual comprehensive health assessments covering medication review, fall risk, blood pressure, nutrition, and mental health screening
• Individualized healthy living plans that set specific, measurable goals around chronic condition management
• Hospital-to-home transition support — coordination with discharge planners to prevent readmissions
• Blood pressure clinics and wellness programs including evidence-based offerings like Tai Chi for Balance and Bone Builders
• Ongoing check-ins that catch emerging problems before they become emergencies

A peer-reviewed study published in Health Services Research in March 2026 found that SASH participants gained up to 1.3 additional life-years and 1.0 quality-adjusted life-year compared to non-participants. The program's cost-effectiveness ratio — $4,013 to $8,344 per QALY gained — ranks far below the standard U.S. healthcare benchmark of $100,000 per QALY.

Who Qualifies

SASH is provided free to Vermonters on Medicare, regardless of income. Participants are grouped into local panels, with coordinators and wellness nurses based in local affordable-housing communities. Ask whether a panel serves your parent's housing or community.

Enrollment varies by region — some panels have open capacity while others maintain short waitlists. The quickest way to check availability is to ask your parent's regional Area Agency on Aging.

How SASH Differs from Home Health and Home Care

SASH is not a replacement for hands-on care. The program does not send aides to help with bathing, dressing, or meal preparation. It is a coordination and prevention layer — the wellness nurse monitors health trends, connects your parent to community resources, and intervenes early when something changes.

Think of it as the connective tissue between your parent's primary care doctor and the day-to-day reality of aging at home. The doctor sees them a few times a year. SASH fills the gaps.

If your parent needs actual personal care assistance — help with ADLs, medication administration, or safety supervision — those services come through Vermont's Choices for Care program, the Attendant Services Program, or private-pay home care agencies.

How to Enroll

Contact SASH through their website at sashvt.org or call your regional AAA. You can also reach the Senior HelpLine at 1-800-642-5119, where an options counselor can confirm whether a SASH panel operates near your parent's home and whether it has open slots.

For families managing a parent's full aging-in-place transition — from Medicaid eligibility and caregiver hiring through home modifications and estate protection — our Vermont Home Care Navigator covers the complete process, including how SASH fits alongside the state's other support programs.

See more Vermont guides →