No Wrong Door

1. No Wrong Door Molly Huffstetler, M.S.W. No Wrong Door Coordinator Virginia Department for the Aging October 15, 2007

2. Virginia’s Key Strategic Initiative for Long Term Care No Wrong Door

3. The Strategy at 20,000 Feet • Improve consumer experience and provider efficiency for the procurement and provision of long term care services to Virginia’s seniors and adults with disabilities. • Collaboration of service providers • Identification of service options • Automation and streamlining of key processes

4. The Current Situation:A Fragmented System of Care • Eleven state agencies • At the local level there are: • 25 AAAs • 34 Health Departments • 120 Social Service Departments • 40 Local Community Services Boards • 16 Centers for Independent Living • Over 7,000 public and private organizations and agencies that provide some type of service to these populations

5. Frederick Clarke Loudoun Warren Fauquier Fairfax Shenandoah Prince William Rappa- hannock Page Rockingham Culpeper Stafford Madison Highland King George Greene Westmoreland Orange Augusta Spotsylvania Bath Albemarle Northumberland Caroline Louisa Richmond Essex Rockbridge Accomack Fluvanna Nelson Hanover Middlesex Alleghany Lancaster Goochland King & Queen King William Amherst Buckingham Mathews Botetourt Powhatan Cumberland Richmond New Kent Henrico Craig Gloucester Charles City Appomattox Chesterfield Northampton Amelia York Bedford James City Giles Roanoke Prince Edward Buchanan Prince George Campbell Montgomery Nottoway Surry Hampton Bland Dickerson Dinwiddie Tazewell Charlotte Pulaski Norfolk Isle of Wight Lunenburg Sussex Wise Franklin Russell Floyd Wythe Pittsylvania Smyth Virginia Beach Chesapeake Brunswick Southampton Grayson Suffolk Lee Scott Grayson Henry Halifax Mecklenburg Washington Greenville Carroll Patrick Portsmouth Overlapping Service Areas Health Districts Area Agencies on Aging Community Services Boards Department of Social Services

6. Intake Forms Daycare; Transportation Home Delivered Meals Non-medical In-Home Assistance Blind and Vision Impaired Deaf and Hard of Hearing Mental Health Services Seeking Services Before No Wrong Door Needs Assessment Several Medications Can’t Drive Short-term Memory Loss Vision Impairment Hard of Hearing Incontinent Possible Depression Check Personal Directory Area Agency on Aging Referral Form Next Agency Referral Form

7. By 2030, there will be 1.3 million more older Virginians than there were in 2000—a 120% increase Older Virginians will comprise 25% of all people living in the State There will be an increase in the number of people with special needs Without a change the situation will only get worse! “Virginia is not well positioned to meet a potential increase in demand for services, because existing services are provided through a patchwork approach that does not provide appropriate services.” House Document #10

8. Solution No Wrong Door Under the leadership of Governor Kaine and HHR Secretary Marilyn Tavenner

9. No Wrong Door Objective • To offer a single point of entry for accessing public and private health and human services for adults in Virginia: • By phone • On-line • Physical locations

10. Great Idea – How does it work? • Collaboration of service providers • Web-based technology

11. Collaboration • State Agencies • Department of Medical Assistance Services – DMAS • Department of Mental Health, Mental Retardation, and • Substance Abuse Services – DMHMRSAS • Department of Rehabilitative Services – DRS • Department of Social Services – DSS • Office of the Attorney General – OAG • Virginia Board for People with Disabilities – VBPD • Virginia Department for the Aging – VDA • Community Integration for People with Disabilities • Local Partners • Area Agencies on Aging (AAAs) • Centers for Independent Living (CILs) • Community Action Agencies (CAAs) • Community Services Boards (CSB’S) • Field Offices of the Department of • Rehabilitative Services (DRS) • Local Departments of Social Services (DSS)

12. Collaboration withPrivate Partners

13. No Wrong Door Resource Team Chaired by the Deputy Commissioner of the Virginia Department for the Aging. State Government: HHR Secretariat, DMAS, DMHMRSAS, DSS, VDA, Community Integration for People With Disabilities, VACSB, State Groups: SeniorNavigator, 211 Virginia, Centers for Independent Living Agencies on Aging: Peninsula, V4A Private Providers Self Advocates/Consumers

14. Peninsula Agency on Aging – James City, York, and cities of Newport News, Hampton, Williamsburg, and Poquoson Valley Programs for Aging Services – Augusta, Bath, Highland, Rockbridge, Rockingham, and cities of Buena Vista, Harrisonburg, Lexington, Staunton, and Waynesboro Senior Connections, Capital Area Agency on Aging – Charles City, Chesterfield, Goochland, Hanover, Henrico, New Kent, Powhatan, and city of Richmond Bay Aging – Westmoreland, Northumberland, Richmond, Lancaster, Essex, Middlesex, Mathews, King & Queen. King William, and GloucesterMountain Empire Older Citizens, Inc. – Lee, Wise, Scott, and city of NortonRappahannock Rapidan Community Services Board/Area Agency on Aging – Orange, Madison, Culpeper, Rappahannock, and Fauquier Pilot Communities Led by the AAA

15. Technology The application is built on open source technology that: • Can exchange data with other databases upon identifying common elements of interest • Has the flexibility of several hundred permutations of user permissions to enable administrators to provide only needed access • Collects client information locally keeps it confidential while aggregate data can be viewed by the state to meet reporting requirements • The system is compliant with all state and federal confidentiality regulations • Data can be shared between staff or agencies of the system on an as needed basis

16. Technology • The GetCare System includes the following modules: • Information and Referral (I&R) • Uniform Assessment Instrument (UAI) – 12-page Virginia assessment for public pay services provided by Health and Human Resource agencies. • Case Management / Progress Notes • Enrollment/Service Unit Tracking • Reporting

17. Information and Referral Tool • Ability to enter and track client requests for information, referrals and assistance. • Electronic doorway for professionals to over 21,000 services in SeniorNavigator. • A great way to match the two together. • Ability to track unmet needs and provider trends within agency and community.

18. UAI Tool • Paper format has been translated into an on-line, convenient and accessible form. • Leveraging the use of a common client database makes sharing assessments within, and between agencies possible. • Existing assessment data can be imported to and exported from the new system. • Processing of client and assessment data no longer has to be done centrally within an agency.

19. Case Management Tool • Same client database as I&R and UAI tools. • Contains many of the data elements from the UAI tool. • Expanded demographic information, additional assessments, service enrollment, VA specific financial eligibility information, progress notes and Care Plans.

20. Seeking Services with “No Wrong Door” Area Agency on Aging Hospitals, Nursing Homes Several Medications Can’t Drive Osteoporosis Memory Loss Vision Impairment Hard of Hearing Lack of funds Depression Community Services Board 211 Centers for Independent Living Agency Intake Coordinator Intake and Assessment Adult Day Centers Local Departments of Health Local Social Services Transportation Providers NWD Portal GetCare’s Shared Client Database and SeniorNavigator’s Service Provider Database Health Prevention and Information Personal Care Home Delivered Meals Adult Day Care Transportation Service Providers Referral Physical Location

21. Challenges • Providers must adjust business practices to accept information entered by other providers • Common set of data elements to meet everyone’s requirements for eligibility • Cost of integrating the myriad of software applications that are used by various human services providers • Competing priorities

22. Benefits to Service Providers • Streamline administrative processes and eliminate duplication of effort • Information collected by other providers can be verified and updated • Decrease time with paperwork; increase time with clients • Unmet needs are tracked • Medicaid eligibility is streamlined

23. Benefits to the Commonwealth • Increased access to Home and Community-based services • Decrease in unnecessary institutional placements • Financial savings • Clear picture of aging services • Gaps in Services • Trends for Future Planning • Tools to help them work more efficiently • Share Information • Eliminate Duplication of Effort • Tools that can be accessed from anywhere • Web-based

24. Benefits to the Consumer • Increased access to Home and Community-based services • Decrease in unnecessary institutional placements • Financial savings • Pre-qualifying eligibility • Improved outcomes • Services faster • Less frustration • Greater opportunity for consumer direction • Web-based • Baby boomers preference

25. The ultimate benefit of No Wrong Door will be extended independence and improved quality of life for seniors, their caregivers and persons with disabilities.

26. Peninsula Agency on Aging – James City, York, and cities of Newport News, Hampton, Williamsburg, and Poquoson • Williamsburg Community Health Foundation • United Way of Williamsburg • Local Coordinator meeting with area partners (public and private) • York County Director of Special Programs on local No Wrong Door Advisory Council