Burlington resident Jeanne Daley, 91, is a prime example of the power of bringing prevention efforts right into the home. Four years ago, she had difficulty walking, even with a cane. Now she walks regularly - every day, without a cane - and she recently enjoyed waltzing at a ballroom-dance class.
"I never thought I'd be able to dance again," says Daley. "I'm doing more and more things I didn't think I'd be able to do. I feel like I'm getting younger instead of older. It's been just wonderful for me."
Jeanne Daley's experience is a powerful example of what can happen when Vermont leverages the expertise of home health agencies to go beyond the core services allowed under Medicare rules.
Improved health, reduced growth in Medicare spending and more health-savvy older adults: these are the findings of a recent federally funded
third-party evaluation of older adults living in Vermont affordable housing communities and enrolled in
SASH® (Support and Services at Home), a statewide, collaborative program that helps people stay healthy and remain at home. This is the program Jeanne Daley credits with the progress she has made over the past four years.
The new report found that
participants reported less difficulty managing their medications, higher overall functional status and greater awareness of the relationship between nutrition and health. Members of SASH groups which primarily served residents living at congregate, affordable-housing communities had
fewer hospital admissions and saved an estimated $1,227 per person per year in Medicare expenditures.
Nurses and other staff from our member agencies provide a variety of services for SASH participants. They assist clients in making smooth transitions to their homes after discharge from hospitals, skilled nursing facilities or other institutions and provide ongoing wellness nursing services. Each of our member agencies lends its extensive expertise to local SASH inter-professional teams that meet monthly to consider the specific needs of participants.
Home agencies are central to the success of another popular Vermont program known as Choices for Care. The program has shifted the balance of long term care services from nursing facilities to the community, where most people prefer to be. From 2005 to 2014, the percentage of people eligible for nursing facility care who were living in nursing facilities decreased by 19 percent, while the percentage living in the community increased by 74 percent. Today, nearly 500 fewer Vermonters live in nursing facilities than did so in 2005, even as Vermont's population has aged. Vermont's home health agencies provide the case management, nursing services and personal care that make the program a success.
In early 2017, Vermont opened a new chapter in health care reform aimed at producing more results like this. A coalition of providers and state officials began to implement a new agreement with the Federal Centers for Medicare and Medicaid Services (CMS) known as the "all-payer model." The agreement is designed to change the payment incentives across the health care system to improve support for preventive services - helping healthy Vermonters stay that way, and Vermonters with chronic illnesses be as healthy as they can be.
Vermont's home health agencies are deeply engaged in the all-payer model. This is good news for Vermont. We already know that when our home health agencies are part of the solution, the results are striking.
