How No Wrong Door is uncomplicating long-term care

Care transitions for older adults from hospital to home or hospital to nursing home can be uncertain, frightening and risky. These changes can impact safety, mental and physical health and outcomes, according to the Administration for Community Living.

Families are often left to fend for themselves when finding services or community programs for even trying to arrange transportation to and from physicians' offices for their loved ones. Our long-term care system is fragmented, complicated, difficult to navigate, and administered by multiple federal, state and local agencies. Assessments and eligibility often differ between agencies or programs.

As the ACL noted, "Individuals trying to access new [long-term services and support] find themselves confronted with a maze of agencies, organizations, and bureaucratic requirements at a time when they may be vulnerable or in crisis. These issues frequently lead to the use of the most expensive forms of care, including institutional care such as nursing homes or extended hospitalization, and can cause a person to quickly exhaust their resources."

There are numerous state and federal programs designed to help older people and families navigate this complex maze, but many are not well known. Journalists can help provide solutions for their audiences, reducing the stress, time and cost of finding and coordinating long-term care. This could also help people discover options that may allow a loved one to live in the community for longer.

More about the No Wrong Door System

One care transition solution reporters can highlight is No Wrong Door. This one-stop coordinated system provides information and assistance to people needing either public or private resources, to professionals seeking assistance on behalf of their clients, and to individuals planning for their future long-term care needs.

The system also serves as the entry point to publicly administered long-term supports, including those funded under Medicaid, the Older Americans Act,Veterans Health Administration, and state revenue programs.

It provides streamlined access to public programs and benefits like:

No Wrong Door helps older adults and families arrange community services and support needed to remain at home and avoid unnecessary hospital readmissions. States help ensure appropriate training for program staff.

The program was established by the Administration for Community Living and the Centers for Medicare & Medicaid Services in the early 2000s and now includes the Veterans Health Administration.

The goal was to create a navigable access point for older adults and people with disabilities to the services and supports they need to maintain quality of life, independence, and the ability to keep living in the community, according to Advancing States, a coalition of 56 state and territorial agencies on aging and disabilities and long-term services and supports directors.

This map from the Administration for Community Living details the states and territories that participate in the No Wrong Door program and have legislative and/or gubernatorial support.

States have configured No Wrong Door systems to align with their benefits service delivery and design. And some states have relied on county-based partnerships, while others have partnered with the aging network, 211/311 information and referral agencies, and/or have developed online resource hubs.

The service array offered within a No Wrong Door System may vary throughout states, but the foundation of all systems include:

Person-centered counseling is a core tenet of the system. No Wrong Door engages people in options counseling regardless of age, income or disability status. Options counseling is a person-centered discussion that helps people to weigh their goals, values, preferences, available supports, and plan for long-term care, including unbiased, objective information on a range of alternatives, regardless of payor, such as:

People can contact a state or community based organization to access information or obtain counseling or other services regardless of the person's age, income, or disability status.

As of February 2024, the national impact of the No Wrong Door system encompasses:

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