The Green Mountain Care Board (GMCB) is currently soliciting comments and questions on its Act 167 report regarding the future of healthcare in Vermont, in particularly its ongoing cost challenges and opportunities for transformation. This process is happening as Vermont's "All Payer" waiver is ending and a new model called AHEAD is being considered.

On Tuesday evening July 30, GMCB and Porter Hospital held an open public session to present findings from the Act 167 study and gather feedback. The presentation focused heavily on housing as a key driver of health care costs and outcomes, both due to the workforce housing shortage driving up labor costs and the lack of access to quality affordable housing causing worse health outcomes especially among low-income and vulnerable Vermonters.

AHW provided the following public comments online to encourage that healthcare transformation include housing-based health services for low-income residents of affordable housing and the surrounding neighborhoods:

Addison Housing Works serves over 750 families and individuals in Addison County, including some of our most vulnerable neighbors. Nearly half of our residents subsist on poverty-level incomes, and many have multiple mental and physical health challenges. 32% have a self-identified disability and 37% are elderly. Seniors who live in our housing and the surrounding communities have access to a wonderful program called SASH, which stands for Support and Services at home. Run by Addison Housing Works in Vergennes, Bristol, and Shoreham/Orwell and in Middlebury by Vermont State Housing Authority, SASH provides a full-time service coordinator and a quarter-time wellness nurse through Addison County Home Health and Hospice. SASH focuses on prevention and helps seniors age safely in place, so they stay healthier and don't have to move to higher levels of care for as long as possible. SASH is a capitated model that has been funded by the All-Payer Waiver and now must continue to be funded through AHEAD.

In 2021, based on the success of the SASH program, AHW launched the Family Support Program, which strives to offer some of the same services and benefits of SASH to all of our residents regardless of their age. Family Support is funded almost entirely by charitable donations as no state funding sources exist to support this critical prevention and support work.

Tonight I want to stress the importance of investing in community-based prevention models that address the social determinants of health, especially housing. In particular, the SASH Program is critically important to the health of seniors in our region and must continue to be funded. Moreover, similar funding should be allocated to support non-seniors on a capitated basis and embedded in affordable housing. Funding for supportive services on-site at affordable housing developments works on two levels: 1) it directly supports healthy housing as a social determinant of health; and 2) it capitalizes on housing as a platform for other health interventions from health food initiatives to direct health care access on-site where people live.

Home-based care models like the VNA are vitally important but not enough. Enrollment processes, sporadic appointment availability, and lack of coordination with other parts of the health care system all act as barriers to effective uptake of these services among the most vulnerable (and often highest cost) Vermonters. The SASH Program offers a proven model to address these issues where people live. SASH works with existing providers like the VNA but is a person-centered approach to ensuring that a participants' care is holistically integrated across the parts of the healthcare system with which they may interact. For example, full-time SASH Coordinators convene monthly meetings of area service providers to review health needs of panel participants, and monitor hospitalizations and discharges to make sure participants are doing well at home if they do experience a medical event.

Not only does SASH act as a bridge across existing care providers, it also offers preventive services where people live to reduce demand on the healthcare system. For example, SASH sites have a full-time SASH Coordinator who can organize bone builders classes, blood pressure clinics, and simply spot someone who may not be doing well early enough to intervene before they require an ED visit.

Let me tell you a story about one of our residents who participated in our Family Support Program. This person had a disability and several chronic health issues that made leaving their apartment difficult and also jeopardized their housing because they could not complete their recertification paperwork without assistance. This person may have been eligible for services but did not know who to call for help. Their story might have ended there, with the loss of their rental assistance and safe stable housing, likely worsening their health. However, AHW was able to refer this person to our Family Support Coordinator, who not only helped them maintain their housing assistance, she also noticed that this person was out of food and got them signed up for food shelf deliveries. When this person needed medical care, they reached out to our Family Support Coordinator for help making an appointment because they had built a trusting relationship with someone who was there five days a week. In this case, housing was literally health care because of AHW's residential support program.

AHW would like to expand the Family Support Program along the lines of "SASH for All" which is being piloted in other places around the state, but can't for lack of funding. Demand for these services far outstrips supply. Yet SASH has proven to be a cost-effective intervention, leading to reduced Medicare billing in one Gold Standard Evaluation of the program. The same SASH principles should be applied to a preventative housing-based care coordination system for all residents of affordable housing and the surrounding communities, regardless of their age and Medicare eligibility. Investments should be flexible and not require complicated medical billing or enrollment to access. With homelessness at unprecedented levels, housing and services must work together to keep people happy, healthy, and housed.

The Family Support Program has been busy this summer:

• The Manufactured Home Improvement And Repair Program (MHIR) stopped taking applications as of 6/30/24 for anything besides emergency circumstances. The program has helped a total of 32 households in completing applications up to the above deadline since the program began. The total amount of approved grants so far from these household is $263,400.99.
• Working with a few families at Vergennes Community Apartments to have access to meal kits from the Summer Meals for Kids & Teens program. Each meal kit contains food for breakfast and lunch for 7 days for one child.
• Worked with a North Pleasant Street resident to apply for funding through HOPE for three sound machines. The sound machines will assist this resident with sensory and PTSD struggles from the sound of traffic from the main road. The resident noted that the sound machines make a positive difference in their life.
• Have planned for the fall a gathering at Firehouse Apartments with residents and Evernorth.
  

Norma and Michael Freegard (pictured above with Family Support Coordinator Precious Chamberlin, right, and Property Manager Chris Ouellette, left) participated in the program for help repairing their mobile home. Norma and Michael are from Bristol; Michael is semi-retired and Norma is disabled. Because of the grant they were able to get with help from AHW, Norma says "It's going to be warmer this winter and our fuel bill will go down." Michael says, "Everyone [at AHW] is doing a good job helping people." Both agree that the best thing about living at KTP is the neighbors--it is quiet and peaceful.

In May, AHW was finally able to offer Al a unit in Middlebury. Al accepted and with the help of his caseworker at JGHS, AHW, and other community organizations Al is happily housed in his own apartment--no more sharing a kitchen and living room! Even better, Al still gets to enjoy sitting on his porch and sharing a friendly wave with passersby!

Every three years, a consortium of health and human services providers in Addison County conducts a Community Health Needs Assessment (CHNA), surveying the community broadly about their top concerns and priorities regarding the overall health and wellness of our community. The last CHNA conducted in 2021 found that housing topped the list of key needs to support better health. The 2024 CHNA confirmed that safe, decent, affordable housing with services is a key component of a healthy population and a health economy.

Housing is now recognized as a key "social determinant of health" and some medical professionals go so far as to liken safe, decent, affordable housing to a vaccine because of all the preventative benefits a healthy affordable home can provide, from cleaner air, to less stress, to more money for healthy food, education, prescriptions, and regular PCP visits--all things which can lead to better health and fewer illnesses.

When property manager Alice checked in on them a week after they moved in to see how things were going, they replied:

"I'm going to put in some annual flowers to have color, zinnias, cosmos and marigolds. We are going to have our deck with perennials in pretty pots, I love doing container gardens. We are so happy to be here, thank you all at Addison Housing Works, we are blessed, healthy safe environment for us."

On July 2, we were lucky enough to receive a visit from the Senator himself, who toured our net-zero MHC in Waltham, McKnight Lane, and spoke to residents at Armory Lane Senior Housing (pictured above). Senator Sanders was instrumental in funding that development in 2010 through the HUD 202 Senior Housing program. We are so grateful for his dedication to permanently affordable housing in Addison County!

For our next 35th Anniversary featurette, we're highlighting one of AHW's longtime residents of Lindale Manufactured Housing Community in Middlebury, Elaine Lathrop. Elaine began working for Middlebury College in 1980, first as a secretary to the Dean of Faculty Development and then working her way up to Office Manager at the Bread Loaf School of English, where she served from 1994 until her recent retirement in 2022. One of Elaine's favorite pastimes is quilting. She writes, "I actually started quilting because of my mom. In the fall of 1994, she went to a quilting club meeting and came home very enthusiastic. She said I had to come with her the next month which I did and was hooked. As a new quilter, I took as many classes as I could and have even taught a few classes at Quilter's Corner of Middlebury Sew and Vac. I belong to two quilting groups: Red Clover Quilters and Milk and Honey Quilter's Guild. I thank God for showing me this path of creativity as it allows me to be of service to humanity." Read Elaine's housing story below!

The park roads received minor damage; last summer, AHW partnered with the Lewis Creek Association and Addison County Regional Planning Commission to conduct flood hazard mitigation work in Hollow Brook that hopefully prevented the damage from being much worse.

Thankfully, AHW has been able to repair much of the damage, and we've been able to deploy our Family Support Program staff to help residents apply for relief funds through CVOEO, the Red Cross, and the Manufactured Housing Improvement and Repair program. Residents are back in their homes for the time being, but there remains much work to do to make sure the park is safe and flood resilient against future events. Volunteers from UVM are helping AHW assess the feasibility of long-term infrastructure repairs and improvements that would be necessary to protect the park from permanent lot closures and displacement.

Meanwhile, in positive news, we received a $2,500,000 Congressionally Directed Spending award from Senator Sanders to upgrade the septic infrastructure at all our Starksboro parks including Lazy Brook, Hillside, and Brookside. This award recognizes the critical importance of preserving our state's Manufactured Housing Communities as vital affordable housing resources and making sure they have equal access to safe and sanitary wastewater treatment systems. We at AHW will continue to work tirelessly to engineer solutions that keep our MHCs safe for current residents and permanently affordable for future generations.

AHW's July Board Meeting will be held Thursday, July 25, at the National Bank of Middlebury at 30 Main St in Middlebury or via Zoom. Please RSVP below to receive the Zoom link and meeting packet.

• Agenda
  
• June Minutes (Draft)