What is door-through-door service in NEMT?
Door-through-door is a NEMT assistance level where the driver helps the rider from inside the pickup building to the vehicle, then from the vehicle to inside the destination, such as the lobby or check-in desk. It goes one step past door-to-door. Not every program offers it, and ADA paratransit is generally not required to provide it.
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What door-through-door means
Door-through-door service takes the driver’s help past the building entrance. NEMTAC’s Levels of Service Standard (October 2024) defines it as assistance from inside the pickup location to the vehicle, and from the vehicle to inside the drop-off location. In practice the driver meets the rider in a lobby, hallway, or apartment and walks them in to the check-in desk or waiting room at the other end.
It sits between door-to-door, which stops at the outer door, and hand-to-hand, which adds a formal handoff to a caregiver. The federal United We Ride definition groups the two as “door-through-door/hand-to-hand” service: help through the door of the destination to another assistant or caregiver.
Where it is offered, and where it is not
Door-through-door is a contract term, not a federal right. Coverage varies:
- NEMTAC standard. Lists it as its own level, with drivers trained to help riders inside both locations.
- Minnesota. Its statute says driver-assisted service includes help with getting the rider admitted to the medical facility.
- CareOregon. Its door-to-door level already includes walking the rider to the waiting area at the destination. Hospital discharges get more: the driver goes to the nurse’s station and brings any needed equipment.
- Virginia. Offers curb-to-curb, door-to-door, and hand-to-hand only. Drivers may not go beyond the main entrance lobby or main door, and may not enter a residence.
- ADA paratransit. DOT’s Appendix E to Part 37 says a request for door-through-door help generally need not be granted.
How the three higher levels compare
| Door-to-door | Door-through-door | Hand-to-hand | |
|---|---|---|---|
| Driver’s help ends at | The outer door | Inside the building | A named person |
| Driver enters the building | Usually not | Yes | Varies by program |
| Rider can be left alone at the end | Yes, at the door | Yes, inside | No |
| Typical rider | Needs a steadying arm | Frail, low vision, or unsure of the building | Cannot be left alone at all |
Who needs it
Door-through-door fits riders who can be left alone once inside but cannot find their way or move safely through a building by themselves. Examples include frail older riders, riders with low vision, and patients leaving a hospital unit. Our guide to hospital discharge transportation covers discharge pickups in more detail.
Driver rules and planning
The driver’s limits still apply inside the building. Virginia’s curb-to-curb rules already exclude lifting a rider, and CareOregon bars drivers from carrying riders up or down stairs. A rider who needs to be lifted or carried is a stretcher or stair chair trip.
Going inside also means leaving the vehicle. If other riders are on board, a solo driver cannot walk one rider in without leaving the rest alone. Put door-through-door pickups first or last on a run, or send a second staff member.
The trip bills under its mode code, such as A0130. In HealthRide, facilities can track vehicles live, so staff can have the rider ready inside when the driver walks in. See the live map.
Frequently asked questions
- How is door-through-door different from hand-to-hand?
- Door-through-door brings the rider into the building. Hand-to-hand adds a custody handoff: the driver does not leave until a caregiver or staff member takes responsibility for the rider. NEMTAC's standard lists them as separate levels.
- Do ADA paratransit systems have to offer door-through-door service?
- Generally no. DOT's guidance on reasonable modifications says paratransit drivers should usually open an exterior building door on request. A request for help past that door generally need not be granted, because it could fundamentally alter the service.
- Can the driver go into a rider's home on a door-through-door trip?
- Only where the payer allows it. NEMTAC's definition starts the help inside the pickup location. CareOregon bars drivers from going inside a private home, or into a rider's room in a care facility, unless the brokerage has trained and authorized them. Virginia lists no door-through-door level, and its drivers may not enter a residence or go beyond the main lobby.
