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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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NWD Indicator on LTSS Scorecard
Description: The Long-Term Services and Supports (LTSS) State Scorecard—a compilation of state data and analysis—showcases measures of state performance for creating a high-quality system of care in…
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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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The Collaborative on Health Reform and Independent Living: COVID-19 and Transition Services in CILs
Description: This report describes findings from a 2021 survey of Centers for Independent Living (CILs) on care transitions. CILs were asked to compare the volume of pre-pandemic transitions…
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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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Indiana: D-SNP Care Coordination Orientation
Description: 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…
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Indiana: D-SNP Care Coordination Orientation
Description: 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…
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Indiana: D-SNP Care Coordination Orientation
Description: 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…
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Indiana: Care Transitions Program Pitch Deck for Hospitals
Description: 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…
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Indiana: Care Transitions Program Pitch Deck for Hospitals
Description: 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…
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Indiana: Care Transitions Program Pitch Deck for Hospitals
Description: 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…
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Indiana: Care Transition Process Flow
Description: Through an ACL NWD Business Case grant, Indiana demonstrated that 1) person-centered counselors help individuals access HCBS and avoid institutional care in a nursing facility;…
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Indiana: Care Transition Process Flow
Description: Through an ACL NWD Business Case grant, Indiana demonstrated that 1) person-centered counselors help individuals access HCBS and avoid institutional care in a nursing facility;…
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Indiana: Care Transition Process Flow
Description: Through an ACL NWD Business Case grant, Indiana demonstrated that 1) person-centered counselors help individuals access HCBS and avoid institutional care in a nursing facility;…
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Federal Healthcare Resilience Taskforce: Alternate Care Site Toolkit
This toolkit provides medical operations guidance for state, local, tribal, and territorial entities on operationalizing alternate care sites during the COVID-19 pandemic.…
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CMS: Early Use of Community-Based Long-Term Services and Supports and Lower Downstream Use of Institutional Care Slide Deck
Description: This slide deck presented by CMS on June 7th, 2018 includes information and data on a study conducted to examine if community-based LTSS can lead to decreased usage of institutional…
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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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ACL: Episode 1: Supporting COVID-19 Challenges Through Care Transitions Partnerships
Description: Join Tim McNeill as he discusses best practices associated with care transitions amid the COVID-19 pandemic, where he will facilitate and provide guidance on how to support your local…
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AARP: Effective Transitions between Care Settings
Description: This brief details six ways states can measure and improve their care transitions programs between acute and long-term services and supports settings.…
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ACL: State Examples of NWD Funding
Description: This document provides examples of how NWD Systems can use a variety of funding streams to support development and sustainability. Click here for more information on sustaining a NWD…
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RTC: People with Disabilities Still at Risk in Congregate Care Settings Brief
Description: "People with Disabilities Still at Risk in Congregate Care Settings" summarizes CMS data at county and regional levels to inform community response to the recent increases in COVID-19…
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ACL: Five Practical Ways ADRC/NWD Systems Can Reach Out to Nursing Facilities During the COVID-19 Pandemic
Description: This document provides five ways ADRC/NWD Systems can reach out to and engage with nursing facilities in response to the situations the facilities are facing and how ADRCs can respond…
NWD Technical Assistance Community
A collaboration space for No Wrong Door (NWD) community and partners