No Wrong Door is a virtual Long Term Services and Supports System, statewide network of shared resources, and a wise investment by foundations, sponsors, corporate supporters, and government partners. With endorsements from a wide variety of partners and a solid track record of success, No Wrong Door is helping older adults and individuals with disabilities remain in their homes and communities. By uniting a robust technology system and a network of partners, working together with individuals and their preferences at the center, No Wrong Door is increasing health access, improving quality of life, and containing health care costs.
The social determinants of health are the conditions, in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. For example, an individual discharged from the hospital will likely have far better health outcomes if they have nutritious meals, transportation to physical therapy and follow-up medical appointments, and they take their medication as prescribed. Supports like home-delivered meals, help in the home, transportation, medication management and care coordination can often mean the difference between living independently again or long-term institutional care. No Wrong Door Partners work closely together as a network and utilize the No Wrong Door technology to help individuals and families understand their options and connect with the services that best support their unique needs.
The shift from institutionalization to home and community-based services not only aligns with the life goals of most older adults and individuals with disabilities, it appears to be more cost effective, as well. While still a relatively new approach – less than 20 years, evidence is mounting that the cost savings to individuals and communities is significant. AARP Public Policy Institute spotlighted such findings in their report, “State Studies Find Home and Community-Based Services to Be Cost-Effective.” The features that make No Wrong Door most effective include:
The long term outcome for No Wrong Door is that individuals of all ages, incomes, and abilities will achieve their unique goals for community living through streamlined access to community supports and coordination between providers of Long Term Services and Supports. More immediate outcomes include:
Virginia’s No Wrong Door System uses a Continuous Quality Improvement (CQI) process that includes soliciting input and feedback from diverse stakeholders who use, interact with, or are potential users of the No Wrong Door System on the responsiveness of the No Wrong Door System to their varying needs. CQI processes include continuous feedback from stakeholders, formal assessment of the No Wrong Door System end users, directors of organizations that use No Wrong Door, feedback from organizations that have attended a demonstration of the system but are not yet using it, and input from over 50 advocacy organizations.
A history of Long Term Services and Supports systems, polices, and practices strongly favoring institutionalization left older adults and individuals with disabilities to face significant health access barriers in the past. The U.S. Supreme Court’s landmark Olmstead decision in 1999, which held that unjustified institutionalization of individuals with disabilities, equals discrimination, set in motion a paradigm shift for individuals, who need home and community-based services (often also called Long Term Services and Supports). The Olmstead decision paved the way for critical change to deep-rooted health disparities.
The shift from institutional care to home and community-based supports has left many without the knowledge or understanding of how to navigate a complex and often siloed support system. The National Health Policy Forum reports that, “to those unfamiliar with aging or disability services and who need help for themselves or their family members, accessing Long Term Services and Supports can be confusing, difficult, and frustrating. Most people, even those who have financial resources to pay for care themselves, do not know where to get help or may not know how to access preferred services.” Similarly, Disability Health Journal notes that, “programs and policies that provide Long Term Services and Supports are usually segmented by age of the consumer and nature of disability, creating categorical service systems. This practice has created silos dividing aging and disability policies, programs, and consumers at federal, state, and local levels into distinct service recipient groups.”
By 2035, one in three U.S. heads of household will be aged 65 or older. Likewise, the U.S. will see a 76% increase in number of households that include individuals with disabilities (Harvard, 2017). More than 25% of adults in their 60s say, “they are not confident communities will have the resources and services they need to lead a healthy and independent life over the next five to ten years” (NCOA, 2012). Access to accurate and complete information about health and support options is imperative in order to improve quality of life, prevent unnecessary hospitalization, avoid institutionalization and reduce health care costs. Built on the principles of Olmstead, No Wrong Door is designed to address these barriers to health care and streamline access to critical community-based supports.
No Wrong Door is built on the philosophy that the best outcomes can only be achieved through a combined effort between public and private sectors. As the number of older adults and individuals with disabilities increases and resources remain flat, it is critical to close the gap using technology solutions such as No Wrong Door, enabling providers to work more efficiently through partnerships, eliminating duplicate efforts, and streamlining processes.
Funding for No Wrong Door is also dependent on public and private support. Virginia has been fortunate to consistently secure federal grant funding for No Wrong Door since 2004, which has supported much of the technology and infrastructure development. The Commonwealth has also consistently provided support for public-sector licensing fees systems and integration between public sector partners. The private sector has made valuable contributions as well, with generous grants from Dominion, Centra Foundation, and United Way.
While this patchwork between Federal, State, and Local funding has successfully seeded No Wrong Door and provided it an opportunity to grow strong roots, long-term sustainability largely depends on everyone paying a small part. Therefore, the long-term funding structure requires organizations and agencies to pay a small one-time-only start-up fee and annual user license fees. These fees are often feasible for medium to large organizations but can sometimes be a barrier for small non-profits. No Wrong Door seeks funders to help offset one-time-only start-up fees for non-profits. Additionally, funding is sought on the community-level to build local capacity to expand No Wrong Door partnerships.
The vision for No Wrong Door was once thought to be far-reaching, yet with perseverance, creativity, and a dedication to public/private partnership, Virginia has received national attention as a thought leader and model for best practices. While making great strides, the future of No Wrong Door weighs heavily on community partners, investing time, talent, and treasure to ensure that older adults and individuals with disabilities remain independent and valued contributors, building healthy communities across Virginia.