Results from a Hybrid Effectiveness-Implementation Trial of a Pilot Shallow Rental Subsidy Program at an Area Agency on Aging

Background and Purpose: Across the United States (U.S.), Area Agencies on Aging (AAAs) are developing programs and partnerships to address rising housing insecurity among older adults. Shallow rental subsidies, a recurring yet moderate form of rental assistance, fill the gap between one-time emergency assistance and permanent, often unavailable, deep subsidies. In 2024, an AAA serving a large metropolitan area established the Shallow Subsidy Pilot Program (SSPP) that provided $330 of rental assistance per month for 12 months to housing-insecure HCBS clients. The purpose of this study is two-fold: to measure the housing and health impacts of the SSPP and examine its implementation in this novel AAA context.

Methods: A hybrid effectiveness-implementation trial was conducted to assess the implementation and impact of the SSPP simultaneously. Effectiveness was measured through a mixed-methods randomized evaluation. Forty HCBS clients with Worst Case Housing Needs were enrolled and randomly assigned to receive services as usual (SAU) or the SSPP alongside their existing services. Housing, well-being, and service utilization outcomes were assessed at baseline, six months, and eleven months via standardized measures and open-ended questions. Quantitative analysis used longitudinal generalized estimating equations, and qualitative analysis followed the Rigorous and Accelerated Data Reduction technique. Mixed methods integration followed the primary data analysis integration procedure. The implementation component of this hybrid trial used a sequential mixed methods design based on the Consolidated Framework for Implementation Research (CFIR). Results from a modified Pragmatic Context Assessment Tool (pCAT) survey of AAA staff informing three staff focus groups. Focus group data were analyzed using a rapid structured approach.

Results: Strong mixed methods convergence was observed for short-term improvements in affordability, enhanced financial well-being, and reduced emergency department use over 11 months. Qualitative data supported a positive impact on overall housing security, but this diverged from the null quantitative. Similarly, qualitative data reflected increased health-promoting behaviors (i.e., attending appointments, meeting basic needs), but no program effects were observed for standardized measures of physical and mental health. Implementation results revealed that a agency-wide “tension for change” and the presence of a housing services team facilitated SSPP implementation. However, a lack of program compatibility and limited information, training, and time functioned as barriers.

Conclusions and Implications: The proliferation of housing insecurity among older adults requires AAAs to develop innovative responses. Results of this hybrid trial indicate that shallow rental subsidies are a promising complement to HCBS that are feasible to implement when agency culture and institutional processes align. This small-scale evaluation is the first step in integrating this intervention into the broad constellation of AAA services. Additional research is needed to access funding through Title III, Part D of the Older Americans Act, which supports evidence-based health promotion programs.