Secure Referral to the Aging and Disability Resource Center

This form is designed for individuals and/or organizations to refer to the Direction Home Aging and Disability Resource Center (ADRC). Referrals can also be made to the ADRC by calling 1-877-770-5558. For any non-emergency questions requiring immediate attention, please call the ADRC directly to speak with a screener Monday-Friday between 8am-5pm. If you have issues regarding your care in a nursing home, assisted living, or home-based setting please call our office and ask to be connected with the Ombudsman department.

Complete as many fields as possible to expedite your referral. 

Please note that the ADRC is experiencing some operational delays due to increased call volume.

Referral Source

Patient Information

Physician Information



An ADRC screener will respond to the web request within 24 hours via email or phone to the contact person you requested. Professional referral sources may receive updates following successful or unsuccessful contact with the person referred.

IMPORTANT: For emergencies, call 911. Call 911, visit the Emergency Department or local hospital, and/or reach out to your doctor for any urgent issues about pressing medical conditions. For Adult Protective Services (APS) referrals, call 1-844-640-8292.

Direction Home’s Aging and Disability Resource Center offers tailored, unbiased and reliable information that provides choices for people to live independently in the place they want to call home for all levels of income and physical need. Our representatives strive to raise awareness on the long-term care options and provide objective information to empower community members and their care team professionals to make informed decisions about the next steps in the process.