HD12 - "No Wrong Door" Study


Executive Summary:
Streamlined, sufficient, and adequately funded long-term support services are integral to the health, safety, and wellness of Virginians. Long-term support services, also known as long-term care, make it possible for individuals with disabilities and those experiencing physical or mental challenges due to chronic illness or aging to live as independently and productively as possible. Long-term support services encompass a wide array of programs, services, and entities aimed at encouraging self-sufficiency and facilitating integration into the community. These services also benefit family members and friends of individuals who use these services to support their role as caregivers. As the number of Virginians over age 60 continues to increase and as Virginia continues to fully integrate individuals who have physical or mental challenges into the community, the need for optimized long-term support services has never been greater.

In Virginia, there are over one million people age 60 and older and over 90,000 Virginians age 85 and older. This represents over 15 percent of the state's population. Over this decade (2000-2010), Virginia's older population will increase much faster than the total population. Virginians 60 and older are also growing more ethnically diverse. During the first 25 years of the new millennium, the percentage of non-white older Virginians is expected to increase faster than the national average. In addition, Virginia's baby boom population is advancing into old age. In 1990, baby boomers represented about one third of Virginia's total population. In 2006, the oldest members of this group will begin turning 60.

The degree of chronic illness and disability among seniors and individuals with disabilities is a key policy and budget issue for the Commonwealth. The aged and disabled populations make up 30 percent of the Medicaid population in the state, but account for 70 percent of a budget that exceeds $4 billion. Because of the high cost of institutionalization (exceeding $50,000 a year in some homes), the Medicaid program pays for more than 2/3 of all nursing home care in the Commonwealth. Most people who enter a nursing home in Virginia either are Medicaid recipients or become Medicaid recipients once they have “spent down” their assets paying for nursing home care. In fiscal year 2004, the Commonwealth spent more than $726 million in Medicaid-funded institutional care and $552 million for home and community-based waiver services.

Optimizing the long-term support network is vital to Commonwealth. Long-term support services are provided through numerous private and public sources and are often difficult for consumers to effectively access. For the past five years, Virginia has helped to support a public private partnership called SeniorNavigator, which was created to be a one-stop resource for health and aging information. While Virginia is fortunate to have a strong network of service providers and the robust database of SeniorNavigator to connect seniors to the vital services they need, this is only half the solution. The other half is developing a comprehensive service coordination system (Community-based Coordinated Services) which: qualifies their eligibility for assistance; ensures that they actually receive the help they need; tracks their progress; measures results; and identifies gaps in services based on need. Historically, referrals between services have been encouraged, however, providers frequently lack the eligibility and availability information about other resources that are critical in helping them determine the best match. Additionally, there is no way to automate referrals, so they are done through paper and phone calls, with no process in place to ensure that a referral has successfully led to enrollment. In addition, most service providers don’t have an efficient way, and in many cases a mutual agreement, to share information about a client. The result is a gross duplication of effort – many providers asking the same questions, and many consumers answering them over and over again.

House Joint Resolution Number 657 of the 2005 Session of the Virginia General Assembly requested that the Secretary of Health and Human Resources study the development of a No Wrong Door approach for Virginia’s long-term support service system and report the findings (Appendix A). In accordance with HJ 657, Secretary Jane Woods convened a task force to evaluate the feasibility of developing a No Wrong Door system for Virginia’s long-term support services.

This report highlights the current national trends in exploring the development of a No Wrong Door approach as well as past, present and future efforts in Virginia to develop its own No Wrong Door approach.