@HUDgov published a large RCT of Integrated Wellness in Supportive Housing (IWISH), providing a Wellness Director & Nurse for older adults at HUD-assisted multifamily properties. Quick take: High-quality RCT finds no impact on any targeted outcome (e.g., transitions to long-term care, unplanned hospital'n) over 3yrs.

Program:

  • IWISH funds a full-time, onsite Wellness Director & a part-time Nurse in HUD-assisted multifamily properties serving mainly older adults. Key goals are to reduce avoidable healthcare costs & help low-income older adults who live in affordable housing successfully age in place.

Study Design:

  • The study randomly assigned 124 HUD-assisted properties in 7 states, containing 14K residents, to treatment (funded to implement IWISH) vs control (services as usual). Based on careful review, this was a high-quality RCT (e.g., baseline balance, no attrition, valid analyses).

  • Program implementation at the T properties was okay not great, with some delays in hiring nurses & enrolling residents at start of the study. 83% of T properties were rated as having high or medium implementation fidelity for all core IWISH components.

Findings:

  • Unfortunately, no discernible impact on any primary or secondary outcomes measured over the 3 years - e.g., 27% T vs 27% C exited the property (due to death, moving, or transitioning to long-term care); and both T & C averaged approximately 2 days of unplanned hospitalization.

Comment:

  • This result was not unexpected: A prior study of the Vermont program on which IWISH was modeled had also found disappointing impacts. I think the fed agencies would do better to instead focus large RCT demonstrations like this on programs with a highly-promising evidence base, as discussed here.

  • Congress extended the IWISH demonstration for two additional years, & longer-term RCT findings will be reported in 2026.

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