Selfhelp Active Services for Aging Model (SHASAM)

Citation: Gusmano, M. K., Rodwin, V. G., & Weisz, D. (2018). Medicare Beneficiaries Living In Housing With Supportive Services Experienced Lower Hospital Use Than Others. Health affairs (Project Hope), 37(10), 1562–1569.

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There is strong evidence that housing conditions affect population health, but evidence is limited on the extent to which housing with supportive social services can maintain population health and reduce the use of expensive hospital services.


To assess whether a housing with supportive services program reduced hospital use and discharges for ambulatory-care sensitive conditions (ACSCs).


Participants were 1,248 Medicare beneficiaries aged 65 and older living in the six Selfhelp affordable housing buildings that offered the SHASAM program. The comparison group was 15,947 Medicare beneficiaries aged 65 and older who lived in other buildings in the same ZIP codes. All resided in Queens, New York.


The Selfhelp Active Services for Aging Model (SHASAM) program includes a culturally competent social worker in each building who connects residents to services and benefits. The program also provides health and wellness programming and activities.


The outcome measures were total hospital discharge rates, lengths-of-stay and rates of discharges for ACSCs.


The study was a retrospective analysis of Medicare claims data from 2014. The authors calculated total hospital discharge rates per 1,000 Medicare beneficiaries in the ZIP code for the intervention and comparison groups. A binary logistic regression model was used in which the dependent variable was an ACSC discharge and the independent variables were age, sex, race/ethnicity, and a dummy variable for ZIP code of residence.


The total hospital discharge rate was 32 percent lower for the intervention group than the comparison group (88.1 per 1000 beneficiaries in the ZIP code compared with 129.4 per 1,000, p<.01). The rate of hospital discharge for ACSCs in the intervention group was 30 percent lower than the comparison group (p<.01). The length of stay for hospitalized residents was 6.38 days, one day shorter than the comparison group (p<.05). A regression analysis found that the odds of being hospitalized for an ACSC were about 43 percent lower among participants residing in the Selfhelp buildings with the SHASAM program than among their counterparts in the comparison group (p<.05).


These findings suggest that investments in housing with supportive social services have the potential to reduce hospital use and thereby decrease spending for vulnerable older patients.