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Nevada: No Wrong Door Partner in Las Vegas Leverages Hospital2Home Care Transitions Model
Key partners: Nevada Senior Services – a No Wrong Door partner in Las Vegas, Nevada Valley Health System – an integrated system of care in Las Vegas and Southern Nevada comprised of six acute care…
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Kansas: Aging and Disability Partners Work Together During COVID to Facilitate Transitions from Nursing Homes
Key Partners · Kansas Department of Aging and Disability Services (state unit on aging (SUA)) · Kansas Association of Area Agencies on Aging and Disability · Central Plains Area Agency on Aging ·…
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New Hampshire's No Wrong Door (NWD) System and Aging and Disability Resource Center (ADRC)s
New Hampshire’s NWD System infrastructure, known as NHCarePath, was supported by the Centers for Medicare and Medicaid Services (CMS) Balancing Incentive Program funding to help establish their…
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New Hampshire: Care Transitions from Facility to Home During the COVID-19 Pandemic
Key Partners: ADRCs, hospital discharge planners, New Hampshire Care Collaborative The Aging and Disability Resource Centers (ADRCs) in New Hampshire (called ServiceLinks) have a long history of…
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Promoting Home and Community-based Services in Washington
Key Partners: ADRCs (CLCs), hospitals, IT vendor, Rush University CHASI (Bridge Care Transitions Model) Washington state continually innovates to promote access to home and community-based services…
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North Dakota Care Transitions and Diversion Activities: Informed Choice Initiative
North Dakota is rolling out a large statewide initiative to expand access to home and community-based services (HCBS) by leveraging their Money Follows the Person (MFP) program and No Wrong Door…
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Care Transitions in Oregon's Aging and Disability Resource Centers
This resource describes the "who," "what," "how," and "where" of a hospital to home care transitions program led by the Multnomah County Aging and Disability Resource Center and Oregon Wellness…
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Linking Technology to Address the Social and Medical Determinants of Health for Safe Medicines Use - Journal of Patient Safety
Combined analysis of data from 2 novel decision support programs yielded complementary findings that together address both medical and social determinants of health.…
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Indiana NWD Business Case: Person-Centered Counseling and Care Transition Intervention
Through an Administration for Community Living (ACL) No Wrong Door (NWD) Business Case grant, Indiana demonstrated that 1) person-centered counselors (PCCs) help individuals who need long term…
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OK NWD and MFP Partnership
Key Partners: State Medicaid agency, ADRCs, ombudsmen Oklahoma used CARES Act funds to contract with the 11 ADRCs that house the Ombudsman program. The contracts solidified a partnership with the…
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MD Blending and Braiding of Funding
Maryland plans to divert individuals from nursing facilities at the point of hospital discharge through strategic partnerships between the ADRC and local hospitals.…
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To contact the ACL/Technical Assistance team, please email: CareTransitions@acl.hhs.gov