Consumer Needs for Long-Term Services and Supports and the Road to Improving the Texas No Wrong Door System




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Purpose: Long-term services and supports (LTSS) encompass a broad range of medical and personal care assistance needed by individuals who are unable to perform self-care tasks due to aging, chronic illness, or disability. The No Wrong Door (NWD) System is a statewide network that coordinates the system of access to long-term services and supports. As an offshoot of the person-centered planning movement, the NWD System is premised on ensuring that no matter where individuals first interact with the system, they are guaranteed comprehensive information, assessment, and services. The primary goal of this work is to identify strategies to optimize coordination between and awareness of the entry points of this system. The evaluation will help the Texas Health and Human Services Commission create a consumer-driven, cost-effective, and efficient system. Methods: Qualitative input was captured through listening sessions in five Texas cities (i.e. Amarillo, El Paso, Fort Worth, Pharr, and San Antonio) which were supplemented with a statewide survey launched in September 2023 to derive understanding from experiences with the NWD System. Target audiences included people with disabilities, veterans, adults aged 50 and over, family caregivers, and LTSS providers. Several tools (e.g., telephone, mail, and Internet) were utilized for increased survey accuracy and response rate. The survey was distributed in both English and Spanish, and a specific QR code and survey link was incorporated to track responses. Results: Of 4,185 survey respondents, 69% self-identified within the target group (excluding LTSS providers), and 61% expressed a need for LTSS in the past year. Of the 52% who applied for LTSS, 44% stated use of LTSS daily, and 14% weekly. The top three problems accessing LTSS include a confusing system, long wait times for services, and not knowing where to get help. 79% of consumers were unaware of the NWD System; 2% unsure. Of the 19% aware, 45% felt very or somewhat uninformed about the system in their community. The reasonability of time spent applying for services, ease of applying for services, and timeliness in handling service concerns were among the lowest-scoring statements regarding the system. Conclusions: Our results form the blueprint for facilitating access to care at the community and agency levels throughout Texas to ensure vulnerable populations obtain a high quality of life. Recommendations for the NWD system include effective community outreach and streamlined application processes for services and supports.