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Supportive Services Demonstration and Evaluation: Testing the Integrated Wellness in Supportive Housing (IWISH) Model

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Supportive Services Demonstration and Evaluation: Testing the Integrated Wellness in Supportive Housing (IWISH) Model


Overview

HUD’s Supportive Services Demonstration is a large, cluster randomized-controlled trial that leverages HUD-assisted properties as a platform for the coordination and delivery of services to better address the interdependent health and supportive service needs of its older residents. The demonstration tests the Integrated Wellness in Supportive Housing (IWISH) model, which funds a full-time Resident Wellness Director and a part-time Wellness Nurse to work in HUD-assisted housing developments that either predominantly or exclusively serve households headed by people aged 62 or over. The Resident Wellness Director and Wellness Nurse proactively engage with residents and implement a formal strategy for coordinating services to help meet residents’ needs. The team:

  • Performs person-centered interviews and health and wellness assessments;
  • Develops Individual and Community Healthy Aging Plans;
  • Assists residents with implementing their plans and accessing needed services and resources;
  • Formally and informally engages with community partners; and
  • Has access to supplemental supportive services funds to support health and wellness needs of residents.

The demonstration is being implemented in HUD-assisted multifamily properties in California, Illinois, Maryland, Massachusetts, Michigan, New Jersey, and South Carolina. HUD contracted with Abt Associates and its partner L&M Consulting to document the implementation of the IWISH model and to measure the impact of IWISH on residents’ housing stability and healthcare utilization. The evaluation compares outcomes for residents living in 40 properties that implement IWISH (the “treatment” group) with outcomes for residents living in 84 similar properties that do not implement IWISH (the “control” groups).

Three reports have been published on the demonstration to date. The First Interim Report provides a description of the demonstration properties’ characteristics and implementation during the first 18 months of the demonstration. The Second Interim Report describes the experiences of staff, property owners and residents at IWISH properties, and successes and challenges to implementation, including assessing fidelity to the demonstration model. The third report is a comprehensive report on the first three years of implementation, utilizing HUD administrative data linked with Medicare and state Medicaid claims data to assess the impact of IWISH on healthcare utilization at three years. The key hypotheses guiding the demonstration are that the IWISH program will reduce unplanned hospitalizations and use of other types of acute care, increase the use of primary and nonacute care, and increase the length of stay in housing by reducing transitions to long-term care facilities.

Congress extended the IWISH demonstration and evaluation for two additional years. A fourth and final comprehensive report, including an analysis of impacts over the entire study period, will be provided at the conclusion of the study.

Research Design

The Supportive Services Demonstration is a rigorous, cluster-randomized controlled trial testing the Integrated Wellness in Supportive Housing (IWISH) model, which funds a full-time Resident Wellness Director and a part-time Wellness Nurse to work in HUD-assisted housing developments that either predominantly or exclusively serve households headed by people aged 62 or over. The evaluation compares outcomes for residents living in 40 properties that implement IWISH (the “treatment” group) with outcomes for residents living in 84 similar properties that do not implement IWISH (the “control” groups) to assess whether IWISH reduces unplanned hospitalizations and use of other types of acute care, increases the use of primary and nonacute care, and increases the length of stay in housing by reducing transitions to long-term care facilities.

The evaluation has two phases. In Phase 1, the study team evaluated the implementation of the IWISH model for the initial three-year demonstration period (2017-2020). The Phase 2 evaluation builds on findings from the initial phase and will measure impacts of the IWISH model for the two-year extension period (2021-2023) and for the full six-year demonstration period (2017-2023). The research designs for both phases of the evaluation are available at the links below.

Download the Phase 1 Research Design
Download the Phase 2 Research Design

Reports Published By HUD

First Interim Report

The report titled Supporting Aging in Place Through IWISH: First Interim Report from the Supportive Services Demonstration documents the baseline characteristics of the residents of the demonstration properties and describes the first 18 months of the implementation of IWISH.

Download Supporting Aging in Place Through IWISH: First Interim Report from the Supportive Services Demonstration

Second Interim Report

The report titled Supporting Aging in Place Through IWISH: Second Interim Report from the Evaluation of the Supportive Services Demonstration contains an analysis of IWISH implementation using data from interviews with staff from the IWISH and control properties, focus groups with residents, and program participant data.

Download Supporting Aging in Place Through IWISH: Second Interim Report from the Evaluation of the Supportive Services Demonstration

Results from the First Phase of the Supportive Services Demonstration

The report titled Supporting Aging in Place Through IWISH: Results from the First Phase of the Supportive Services Demonstration provides a quantitative analysis of the impact of IWISH on residents’ healthcare utilization and housing stability at the end of the first three years by comparing the treatment and control groups along four primary outcomes:

  • Unplanned hospitalizations and use of other acute care;
  • Use of primary care and other nonacute health care;
  • Length of stay in HUD multifamily housing, including frequency of exits from housing; and
  • Transitions to long-term care facilities.

The issue brief accompanies the report and summarizes the evaluation findings of the initial three-year period for a non-technical audience.

Download Supporting Aging in Place Through IWISH: Results from the First Phase of the Supportive Services Demonstration Download the Issue Brief


Quick Links

Click to download the files.