IWISH

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.