The 1999 Supreme Court decision in Olmstead v. L.C. recognized the right of individuals with disabilities to receive services in their home and community. The ruling became a foundation for the development of a statewide program to help older adults and individuals with disabilities to access local services and supports.
Recognizing the complexity of multiple funding resources and bureaucratic regulations, as well as the aging Boomer population likely to require long-term services and supports, the Administration for Community Living partnered with the Centers for Medicare & Medicaid Services in 2003 to develop a system that would become known as No Wrong Door.
A 2004 American Association of Retired Persons (AARP) study of Virginia’s long-term care system found, while there were several strong programs, there were challenges for those trying to get appropriate care. Such challenges included limited choices, inefficiencies, delays or obstacles to obtaining services, and, perhaps most significant, no single point of entry.
In 2005, a House Joint Resolution of the 2005 General Assembly requested then Secretary of Health & Human Services, Jane Woods, convene a task force to evaluate the feasibility of a No Wrong Door approach to Virginia’s long-term services and support system and report its findings. The task force met that summer to develop the tasks for the creation of No Wrong Door.
While studies at the state and national level were being conducted, community and local providers also realized a more collaborative approach would result in streamlined access and more effective coordination.
Three communities helped pave the way, thanks to strong leadership and a network of public and private organizations: Williamsburg and James City / County were supported by the Peninsula Agency on Aging; Greater Richmond found a partner in Senior Connections, the Capital Area Agency on Aging; and Harrisonburg was guided by Valley Programs for Aging Services.
These three agencies partnered with the nonprofit SeniorNavigator, which helps Virginians access long-term services and supports using a high-tech, high-touch approach. SeniorNavigator enhanced its database of more than 27,000 programs with a tool designed to easily search for local services, automate referrals, and securely share data.
In 2006, Virginia used its study findings to apply for and receive Virginia’s first Aging and Disability Resource Center (ADRC) grant to develop No Wrong Door.
Recognizing the success of the three communities and their partnership with SeniorNavigator, the three-year grant called for an expansion to six more communities. The grant was also supported by investments by SeniorNavigator, Dominion Energy, local governments, and private funders in the three pilot communities.
Also in 2006, Virginia received a federal Systems Transformation grant, which provided additional money over a four-year period to develop the No Wrong Door system.
The grants led to a shift in No Wrong Door leadership from exclusively private sector to a public-private partnership between the Virginia Department for Aging and SeniorNavigator. No Wrong Door also expanded from exclusively serving older adults to include individuals with disabilities.
A merger between state agencies resulted in the Virginia Department for Aging and Rehabilitative Services, or DARS, which would serve as No Wrong Door’s public sector lead, with SeniorNavigator serving as the private sector lead. As leads, the agency and nonprofit promoted No Wrong Door, developed and led training, and provided administrative and technical support.
The technology evolved as well. SeniorNavigator developed VirginiaNavigator, which added thousands of services and supports for individuals with disabilities to its provider database. Another innovation required a system-wide renovation: the development of CRIA, the technology cornerstone of No Wrong Door. CRIA stands for Communication, Referral, Information, and Assistance.
Improving service, avoiding duplicative efforts, and breaking down systemic barriers, all while understanding diverse needs, developing and enhancing technology, managing a coordinated statewide network, and complying with federal HIPAA and the Commonwealth’s privacy guidelines is a tall order.
It has taken several years, but proven well worth the investment.
Today, No Wrong Door partners utilize CRIA to share client information (with consent) on secure systems to provide a more holistic picture of the individual’s experience across multiple providers. This is completed through an automated referral process that ensures no one falls through the cracks. No Wrong Door means not having to tell your story over and over; the details are in a central system, saving time and money for providers and the individuals they serve.
Virginia is proud to be a national leader in the development of No Wrong Door, with best practices providing valuable guidance for other states as they develop No Wrong Door technology, partnerships, governance, and person-centered practices.