Transition Care Program
The Transition Care Program is designed to improve older peoples’ independence and confidence after a hospital stay, assisting them to return home, rather than prematurely enter residential care. The program provides time-limited, goal-oriented and therapy-focused packages of services to older people following their stay in hospital. These packages include low-intensity therapy such as physiotherapy and occupational therapy, social work and nursing support or personal care.
The program services:
- Older people where further improvements to their physical, cognitive and psychosocial functioning and improved capacity are achievable, enabling them to live independently
- Older people for whom the focus is on optimising their functioning while assisting them and their families/careers to make appropriate long-term care arrangements
A referral will be made by hospital staff to the Aged Care Assessment Team (ACAT)