[Name of SASH site] SASH
Support And Services at Home (SASH) Program
Explanation of Program Benefits
Support And Services at Home (SASH) brings a caring partnership together to support individuals remaining in their homes as long as possible. The organizations in the SASH caring partnership include the following:
[Name of housing host]
[Name of home health agency]
[Name of area agency on aging]
[Name of mental health services agency]
[Name of other Core Partner identified in MOU of SASH Collaborative]
What Does SASH Provide?
SASH provides a broad spectrum of care coordination and support through this caring partnership. At its most basic level, SASH provides housing based care coordination staff to create an organized, person-centered presence in the community. SASH Coordinators provide general referrals to you to help you obtain information on services and care options available within the community. SASH Coordinators also provide one-on-one support and coordination. SASH Coordinators and Wellness Nurses organize and provide health promotion and prevention based programs on a regular basis.
With your consent, SASH will provide a more comprehensive and holistic system of support to you. This more comprehensive benefit includes an in-person assessment with the Wellness Nurse and regular wellness nurse access, person-centered healthy living planning, a team-based approach supporting you to remain at home and direct communication and planning with discharge staff at the hospital and rehabilitation facilities should you need such support.
To receive the full benefits of the SASH program you will:
(1) Consent to release of information and waive claims for release of information that you authorize. This is done by signing the appropriate forms.
(2) Participate in a SASH assessment.
(3) Participate in developing your personalized Healthy Living Plan.
(4) Have access to your SASH assessment, Healthy Living Plan and provide access to others you indicate in a separate authorization form.
(5) Participate in the development of a Community Healthy Living Plan and help us define programs aimed at maintaining participants’ independence.
(6) Meet to discuss your health and wellness goals as well as help us identify unmet needs to assist SASH in effecting change in state policy and legislation.
(7) Keep the SASH Coordinator informed of hospitalizations or nursing home stays.
(8) Be responsible to identify your own health care providers and to make your own health care decisions.
By offering this program the SASH Partners will:
(1) Arrange for a SASH assessment free of charge.
(2) Maintain a directory of evidence-based and promising programs, for participant review, that have proven to be effective in addressing problems such as falls.
(3) Comply with all applicable state and federal laws regarding confidentiality of your assessment and health record and maintain them as outlined in the Notice of Privacy Practices you will be provided.
(4) With your consent and participation/input, discuss and action plan options for you to consider to help you remain at home.
(5) Develop an individualized Healthy Living Plan with you.
(6) Develop a Community Healthy Living Plan to address unmet needs, contingent upon available funding.
(7) With your consent, communicate with the hospital or nursing home and SASH partners to help coordinate your transition back to your home.
(8) Make our best effort to sustain the SASH program; however, the SASH Partners cannot be responsible for your health care related decisions, or health outcomes.
(9) Welcome participation of all residents regardless of level of health care needs, income or other protected status.
Next Steps
Full Participation in SASH includes three steps:
(1)Review and sign appropriate forms to receive full benefits of the SASH program:
- The SASH Coordinator will explain the SASH program and answer any questions you may have.
- You will review with staff and ask questions about any part of the following documents: this Explanation of SASH Program Benefits, a Notice of Privacy Practices, Waiver and Release, and an Authorization for Use and Disclosure. Your signature on the Authorization for Use and Disclosure will allow us to handle your information and to share your information with your care providers, including your primary care provider.
- Your care providers may also be asking for your signature on similar documents to allow them to share your information with us.
- The Coordinator will arrange for your wellness assessment and person-centered interview.
(2)Assessment:
- One of the members of your SASH Team or a trained volunteer will meet with you, and if you wish, a family member or support person in your home or another convenient location to complete an assessment that will form the basis of your Healthy Living Plan.
- Your SASH Coordinator will meet with you to conduct a person-centered interview.
(3)Healthy Living Plan:
- Your SASH Coordinator will meet with you, and if you wish, a family member or support person to respond to questions, complete your Healthy Living Plan and identify your wellness goals.
Fees
There are no fees associated with the intake process, assessment or development of the Healthy Living Plan and Community Healthy Living Plan. On-going support and care coordination by the SASH
Coordinator and Wellness Nurse are free of charge. Special services such as foot care may be offered for a minimal fee or on a sliding scale basis.
Voluntary Opportunity
This is a voluntary program for you. Our SASH Team will continue to seek your input to better meet your needs. However, if you choose to no longer share your personal health information, please talk with the SASH Coordinator regarding your request. The sharing of your personal health information is not a prerequisite to participating in the community programming offered by SASH.
The SASH Program and the SASH Partners’ ability to participate is contingent upon available funding and the full participation of you and collaborating organizations. The SASH Partners may determine, in their sole discretion, that it must terminate the SASH program if such support is insufficient.
Explanation of Program BenefitsJuly 2012 Page 1