Transition Care ProgramThe Transition Care Program (TCP) is offered through NHW's Health Independence Programs.
The TCP Service
- Transition care targets older people who require more time and support in a non-hospital environment to complete their restorative process to optimise their functional capacity and finalise thier long term care arrangements.
- It is for older people who would otherwise be eligible for residential care.
- Transition care enables a significatn proportion of older people to return home, rather than enter residential care.
- Case management for each client.
- After hours contact in the case of emergency.
The TCP Program is:
- Jointly funded by the Commonwealth Government and the state and territory governments.
- Short-term support and active management for older people following a hospital episode.
- Goal-oriented, time-limited (up to 12 weeks) and therapy-focused care for odler people at the conclusion of a hospital episode and
- Delivered in either a residential or community setting.
To be eligible for a TCP prackage you must be:
- Assessed by an Aged Care Assessment Service (ACAS) in a hospital.
- Complete your episode of hospitalisation in a pubilc or private hospital;
- Medically stable and ready for discharge at assessment;
- Discharged from hospital upson entry to transition care; and
- You wish to access transition care.
You are required to be assessed by the ACAS as being able to benefit from a period of care in a non-hospital environmnet to access low intensity therapy and support (such as physiotherapy, occupational therapy and social work).
Your TCP Case Manager is able to provide, arrange and purchase these services on your behalf and to ensure they are delivered appropriately and will be te contact person for you and your family, as well as the liaison person with other service providers.
We are able to cater to the health needs of all individuals regardless of wthnic background, religion or income.
Services that can be provided through a TCP:
- Case management and coordination
- Personal care
- Home care
- Technical nursing
- Allied health such as physiotherapy, speech therapy and occupational therapy
- Meal perparation and
- other support services as required.
General medical services such as pathology or radiology services, an appointment with your General Practitioner or pharmacy medicines are not included as part of TCP. Your Case Manager can assist you with your appointments but you will need to pay for these services in the usual way.
Fees and charges:
The fees are determined by the Australian Government. The amount contributed will be negotiated when you discuss the TCP with the Case Manager.
Clients will not be disadvantaged fromn accessing the program if they are experiencing financial difficulties or are unable to pay.
Who can make a referral to the program:
Residents fo the Wangaratta region can be referred to NHW's TCP program from any private or public acute hospital.
After being referred to ACAS by a GP or Hospital Liaison Staff you will be required to undergo an ACAS assessment before the TCP team can assess your for a package (see eligibilty criteria).
Referral may be via phone, fax or post.
 Transition Care Program brochure | type: pdf | size: 130 kB |