HUD has publicly posted its April 2021 evaluation of its Integrated Wellness in Supportive Housing demonstration, Supporting Aging in Place Through IWISH: Second Interim Report from the Evaluation of the Supportive Services Demonstration.

The initial three-year demonstration was extended for two-years by Congress in December 2020. The third and final evaluation of the initial three-year IWISH demonstration is expected in late 2022. HUD has yet to distribute any of the $14 million Congress provided for the demonstration’s two-year extension to any of the participating demonstration sites.

The demonstration is designed to produce evidence about the IWISH model’s impact on the housing stability and health outcomes of HUD-assisted older adult residents. The demonstration is to test whether IWISH will affect (1) unplanned hospitalizations and the use of other types of acute care with high healthcare costs, (2) the use of primary and nonacute care, and (3) the length of stay in housing by reducing transitions to long-term care facilities.

The demonstration provided funding for onsite services staff that goes beyond the resources usually available to HUD-assisted multifamily properties. The demonstration funded two onsite wellness staff positions for the 3-year duration of the demonstration: a full-time (40 hours a week) Resident Wellness Director and a part-time (20 hours a week) Wellness Nurse for every 100 to 115 residents living at a property; thus, each IWISH property could have one or more Resident Wellness Directors and Wellness Nurses depending on its number of residents. The people filling those two IWISH positions are intended to work together to support residents’ health and wellness.

The Second Interim evaluation digs deep into demonstration site performance on a variety of metrics and, overall, strikes a positive tone about the demonstration. Among the chief findings:

• Not all IWISH properties implemented all the core components of the IWISH model to a high degree.
• The Resident Wellness Director position was fully staffed at most properties for most of the demonstration period.
• The Wellness Nurse Position was at least partially staffed at most properties for most of the demonstration period.
• The average enrollment rate was satisfactory, but engagement varied across properties.
• Almost all IWISH participants completed an assessment, but privacy concerns were a barrier.
• IWISH staff reported challenges using required case management software.
• Staff at most IWISH properties reported engaging in enhanced Service Coordination activities.
• All properties offered programs focused on health and wellness, but only one-half of IWISH properties implemented evidence-based programs.
• Developing property-wide healthcare partnerships was a challenge.
• COVID-19 required staff to change the way they interacted with residents but not the assistance they provided.

The Supportive Services Demonstration builds on what HUD learned from the Support and Services at Home (SASH) model and earlier studies to advance the knowledge base on the impact of housing-based services on healthcare use and housing stability for older adults.

The third and final comprehensive report, expected in late 2022, will examine whether the IWISH model has any effect on participants’ health and well-being and their ability to remain in their homes (that is, age in place). The final report will measure the IWISH impact on the following resident outcomes:  

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

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

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