Program based in affordable housing sites for older adults and people with disabilities has favorable impact on Medicare and Medicaid expenditures and helps residents remain in community settings.
Many older adults desire to live in their own communities, but low-income individuals with complex health conditions may need in-home supports to remain at home. Services and Supports at Home (SASH) embeds interdisciplinary teams in affordable housing properties to bring health care services and long-term services and supports directly to older adults and people with disabilities. This multi-year mixed-methods evaluation of SASH includes interview data with program staff and partners, survey data of participants, and Medicare and Medicaid claims to understand impacts on health outcomes and spending.
The SASH program led to reduced growth in Medicare expenditures and in Medicaid long-term institutional care for SASH participants relative to a comparison group. SASH program participants also experienced statistically significant slower growth in Medicare expenditures for acute care and specialist physicians. Medicare cost reductions were higher in urban areas, which may reflect greater availability of community resources in these areas. Program participants reported improvements in medication management, and program staff reported that SASH helps residents remain living in their communities.
SASH has the potential to reduce cost expenditures and improve outcomes for older adults and people with disabilities. Notably, SASH may have better outcomes for program participants in affordable housing sites than for broader community participants, as well as for older adults as compared to younger adults with disabilities.