A community resource referral connects a person with an organization that may help with a need such as meals, transportation or support at home. A useful referral identifies the service being requested and the next step. A long list of organizations can leave both of those questions unanswered.
National directories can provide a starting point. The Administration for Community Living's Eldercare Locator connects older adults and caregivers with local resources. Its Disability Information and Access Locator helps people with disabilities and their families find community living supports.
Agree on the problem to solve
Ask the person which concern they want help with and what a useful result would look like. “Needs community resources” is too broad to guide the referral.
In a fictional example, a patient wants to attend a follow-up visit but cannot arrange a ride. The immediate referral question is whether a suitable transport option can meet the date, location and assistance needs. A general brochure about services for older adults would leave the practical problem unresolved.
Explain what the receiving organization does, what information will be shared and how contact will occur. Follow the organization's consent and privacy procedures.
Check the service before recommending it
Treat a directory listing as a lead to verify. Confirm the service area, current contact route, eligibility process, cost questions, accessibility, language support and whether applications are being accepted.
Record when the information was checked. If a resource has closed, changed its intake process or stopped accepting referrals, update the shared directory through the responsible staff member.
AHRQ's referral guidance emphasizes assessing barriers, helping patients navigate referrals and following up on completion. Although written for healthcare referrals, these questions offer a useful starting point for designing a community referral workflow.
Choose an appropriate level of assistance
Some people prefer to make contact themselves. Others may want help finding the correct number, understanding an application or arranging a conversation with the receiving organization. Ask what assistance would be useful.
Avoid describing a service as arranged when only a message has been sent. Distinguish the request, the receiving organization's response and the person's agreement to the next step.
If the requested resource is unavailable, explain that result plainly. Bring the unresolved need back to the care team when it affects the care plan, and explore appropriate alternatives with the person.
Follow the outcome
A proposed referral record can include the need, chosen organization, contact date, response, next action and responsible staff member. Use only information appropriate for that record and sharing arrangement.
At follow-up, ask whether contact occurred and whether the resource helped address the original need. “Referral completed” should have a defined meaning in the local workflow; it should not silently mean only that a form was transmitted.
Review recurring problems such as unanswered referrals, unclear eligibility or inaccessible intake routes with community partners. These are opportunities to improve the referral process.
A reliable referral is a two-way exchange. Use closed-loop referrals to confirm the agency accepted the request. If it did not, ask whether transportation barriers or the caregiver’s capacity make the suggested alternative impractical.
Sources
- Finding Help for Yourself or a Loved One (accessed 2026-09-17) — Administration for Community Living.
- Make Referrals Easy: Tool 21 (accessed 2026-09-17) — AHRQ.