New Grants Help States Evaluate ROI, Business Case for No Wrong Door Systems

ACL has awarded grants to 10 states to quantify the “return on investment” associated with streamlining access to long-term services and supports that allow older adults and people with disabilities to live independently in the community. The nearly $1.2 million per grantee over two years will help demonstrate the impact of https://nwd.acl.gov/index.html">state No Wrong Door systems and evidence-informed practices, including person-centered counseling. The methods and data generated through this grant will help sustain state and national momentum for system change that increases access to community living and reduces unnecessary healthcare utilization.

We know that most older adults and people with disabilities would rather receive long-term services and supports (LTSS) in their own homes than live in a nursing home or other institutions. We also know that community living is usually the less expensive option. Unfortunately, too many people miss out on this “win-win” because they do not know what services are available to them, face bureaucratic hurdles, or find the services too inflexible to meet their needs.

In No Wrong Door systems, multiple state and community agencies coordinate to ensure that regardless of which agency a person contacts for help, they can get connected to services and supports available in their community. All 56 states and territories are working to build No Wrong Door systems. States are at different stages of implementation, which includes training staff and restructuring access points around person-centered principals, streamlining programs and eligibility, and increasing coordination between agencies and partners. These systems emphasize a person-centered approach in which trained professionals listen to and work one-on-one with individuals to identify and access services and supports personalized around their unique strengths, goals, preferences, needs, and desired outcomes.

This streamlined approach has helped many people delay or avoid costly institutional care. However, hard data on the financial impact of these systems remains sparse.

The new No Wrong Door System Business Case Development Grants fill this gap by allowing states to quantify the benefits of No Wrong Door systems and many of the practices they use to increase access to LTSS. Practices that the grants will help evaluate include person-centered counseling and evidence-informed interventions such as care transitions, nursing home diversion programs, and the Veteran Directed Care program. States will identify core outcome measures that reflect both the impact on the lives of older adults and people with disabilities and the associated return on investment. States will then collect and share outcomes data, ultimately detailing what they learn in business case reports.

This work will begin to illustrate the national impact and opportunities of the No Wrong Door approach, as well as provide methodologies and lessons learned that can be shared with other states to help them evaluate the impact of their systems.  

The states receiving grants are Connecticut, Georgia, Indiana, Maryland, New Hampshire, New York, Oregon, Virginia, Washington, and Wisconsin.