Care Transitions Program

Help available after hospital release

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What is the Care Transitions Program?

The Care Transitions Program provides assistance for individuals who are just released from a hospital or rehab stay and need help while they recuperate in their own homes. This help can prevent or delay nursing home placement and hospital re-admission. Care Transitions provides help and support for qualifying seniors for up to 30 days.

How can Care Transitions help me?

The Care Transitions Program may provide a range of services including:

  •  Care Coaching
  • Medication Reconciliation
  • Development of a Personal Health Record
  • Home delivered meals
  • Homemaking
  • Transportation
  • and other needed  services

Who is ELIGIBLE for Care Transitions?

The program is currently available for residents of the area who:

  • Are being discharged from the hospital, living temporarily  in a nursing home or are rehabilitation center patient
  • Have a need for these services

How do I APPLY for the Care Transitions Program?

  • The application process begins with a call to the Elder Helpline at 1-800- 96-ELDER or 1-800-963-5337
  • The Elder Helpline is available Monday-Friday, 8 a.m. to 5 p.m.  Voice Mail is available after hours.