Elevating Assistive Technology Program Partnerships Across the No Wrong Door System

Join Christina Neill Bowen as she goes over the history of the NWD vision and how to elevate assistive technology program partnerships with Joseph Lugo, director of the Office of Network Advancement at the Administration for Community Living.

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Narrator 0:00
Welcome to the No Wrong Door podcast series, brought to you by the Administration for Community Living. In this episode, we'll focus on the value of a No Wrong Door system and how partnerships can link at all levels of a system. This episode highlights partnership opportunities with state AT programs across all four of the No Wrong Door key functions. Our featured host Christina Neill Bowen with the No Wrong Door Technical Assistance Team, talks with Joseph Lugo, the Director of Office of Network Advancement with the Administration for Community Living.

Joseph 0:40
One thing I would share is that when you're thinking about partnering with the vision where it is now with No Wrong Door is not to think of it as one level. There really are four connection points where you could strengthen the collaboration from No Wrong Door and state AT.

Narrator 0:54
This interview highlights why forming partnerships and coordinating our efforts are key to achieve the No Wrong Door vision. So now, let's hear from our featured host, Christina Neill Bowen.

Christina 1:09
I'm gonna start with a really basic question, Joseph, just so that the audience kinda gets grounded in this. What's the value of an ADRC or No Wrong Door system?

Joseph 1:20
That's a great place to start. A couple of ways to approach it, I do think if this was a coin, there's two sides of the coin. There's an efficiency cost savings approach. And then there's the other side of the coin is the consumer experience. Before jumping into it, I would wanna just let the audience know, the actual concept and the vision that started this, actually didn't start in D.C. We took really successful efforts that were occurring in Washington, Oregon, Wisconsin and they were really targeted. How do we rebalance our system in terms of our spending? They really felt like this vision is what's needed, if we wanna increase access to HCBS. And so we said, "Well, how can we start to replicate that?" Because we do think there's value in it. And so, we distributed funds. Started with many times at the state unit on aging, would receive those funds. And so it's actually quite broad in scope, in terms of how the No Wrong Door system looks like, but it didn't start that way. When it started many times states interpreted this as, "Well, this is a program that's within a specific organization like an Area Agency on Aging. And as that vision started to grow many states and organizations like, "Well, no, this is more than just a program. This is really an organization that really needs to partner with other organizations to be able to pull this vision off." And then the most recent, as we started to increase our collaboration with the Veterans Administration and CMS. The vision is now brought into this idea of a No Wrong Door system. So, for all populations and all payers. And so, one of the things, CMS actually took this exact question and says, "What is the value of having a coordinated access system?" And so, they actually looked, did some research in terms of Medicaid data. So it's not all payers, but they looked at the Medicaid data and they looked over a five-year period across 16 states. And what they found was there are real consequences when you go through the wrong door. And so, one of the things they looked at was what's the likelihood in an individual to have a long-term stay in an institution? So meaning 90 days or longer, if they start their LTSS journey in a nursing home? What are their odds? And so, what they found was almost three out of four individuals, like 73%, had a long-term stay when they started in a nursing home. And then they said, "Well, what if an individual starts their journey in the community with HCBS services? Is there a difference? And it was really startling. What they found out was four out of 100 individuals. So, these are all looking at older adults. Four out of 100 older adults had a long-term stay. So there's real consequences, I think both on the spending and efficiency cost savings could be achieved at the state. But also the disruption in terms of the families, in terms of trying to transition and get out of the nursing home. The other thing I would share is that the AARP foundation, the SCAN foundation and RWJ also looked at this, in terms of what is the value of these state access systems and how are they maturing? And so, they really feel like this is a great marker for a high performing state system. And so, it's one of the indicators in their state scorecard. And so, you can go and look up how your state ranks in terms of their No Wrong Door vision. And so I think 50 states last time, participated in this effort. And so you can actually go see, how is our access system, in terms of maturity compared to other states? I would just find it in that way, Christina. Hopefully, that helps.

Christina 4:25
Yeah, that's great, Joseph. And just the acknowledgement that every state has an access system with different levels of maturity, keep in mind. Great. So with that, kind of with what you gave in terms of the history and the value of the No Wrong Door system, why is it sort of a natural partnership or why does it make sense for No Wrong Door systems and programs to collaborate?

Joseph 4:49
Yeah, so we are really strongly encouraged that this synergy that's occurred, we were hoping for it, but just to see it actually happen, it has just been so rewarding. I think for me, it really solidified with an actual situation. Actually, one of their options counselors was sharing a real life story with them. And so an individual called their access system, the ServiceLinks. And so the options counselor received the phone and the caregiver said, "Well, I need a list of nursing homes. I need to put a loved one in a nursing home." And that was all they shared. And so as they were working with the options counselor, they kind of started to just get a rapport and learn more about the situation. And it turned out, the only reason that they needed a list of nursing homes was because the caregiver couldn't get the relative from the car into their home. It was the only reason that they felt like that was the only decision they had. And so they were able to kind of coordinate, get some AT devices and some really, really cool things. They put low cost, low tech things. It turns out, that's all that was needed. And so, it's a really nice synergy. It's a really beautiful fit because whether it's low-tech or high-tech, it's just an extension of the workforce and options to try to help people stay independent in the community. So for me, that marriage for lack of a better word, really works.

Christina 6:03
I love that story. Thanks, Joseph. That really describes it well. But could you share, if I'm a state AT program, how could I find out about and connect with my No Wrong Door system?

Joseph 6:15
Yeah, I think there's two questions. How do I actually find the lead? Which could be a challenge, but I think we're ready to help facilitate that process. We have a list of all the leads for each state for No Wrong Door, as well as the 1-800 number and website. So, I think that's the first question. How do I get actually connected? But then the second, it's a little bit harder and I'm hoping more of it can be fleshed out today is where and how can I get connected once I know who that contact is? And so, one thing I would share is that when you're thinking about partnering with the vision where it is now, of No Wrong Door, not to think of it as at one level. When you look at the functions, there really are four connection points, where you could strengthen the collaboration from No Wrong Door and state ATs. And so, one of those is around governance structure. Not every state is gonna have a governance structure, but the vision is to have one. There's one that says state AT couldn't lead that effort, but one of the areas like Virginia and others, there is an established governance structure. And that there really needs to be AT representation. And so you can increase that voice, increase that advocacy. So, that's definitely one place where I think collaboration can occur. The other area, kind of example, from New Hampshire is around person centered counseling and information referral. There's a lot of training possibilities and potential of coordinating with the broader No Wrong Door system or we're really trying to help provide support for the state No Wrong Door systems around getting access to vaccinations, trying to improve and enhance our cultural competency, when serving different populations. There's a tremendous push of trying to have services that address SDOH. But we're making the argument that if you don't have a workforce that's culturally competent, organizations that are part of the community, then it won't matter. And so we're really trying to work on that area as well. And then the fourth function is this idea of streamlined access. A number of states have really tried to help put some of their eligibility forms online, trying to make it easier. But are there some accessibility issues that the state AT program could help through that process? So when you are looking at the type of partnerships, I would look at at those four different levels, because I think the ideas will be easier. And I think trying to figure out partnerships will be a little bit easier to do as well. So not only at the state level, but also at the local level.

Christina 8:27
Yeah. Great. Any last kind of words, Joseph?

Joseph 8:30
No, the only thing I'd say is I just thank you guys for the investment you're making. I mean, up to the highest levels within our agency, we're excited about this collaboration. We think the AT, the No Wrong Door helps extend the reach for many state AT programs. And we think the state AT provides the No Wrong Door system and their workforce more options, in terms of trying to help people stay independent. And so, just thank you for your time. And we're hopeful that we will be able to continue to find incentives for states to continue to partner, because it's just a really good fit.

Christina 8:57
Excellent. Thanks so much, Joseph.

Narrator 9:04
Thanks for listening. For more information, visit TA-Community.com. 

Narrator 9:11
Views and opinions expressed in this podcast are those of the presenters and do not necessarily reflect the view of ACL or any of its officials.