Transition Care

The Transition Care Program is designed to improve older people’s confidence and independence after a stay in hospital. Our aim at Beaufort and Skipton Health Service (BSHS) is to support older people who are leaving hospital to return home rather than prematurely moving into residential care. The program facilitates care for older people who have completed their hospital stay and need more time and support to make a decision on their long term aged care goals and options.

Transition care is goal orientated, time limited and therapy focused. It provides older people after they have had a hospital stay with a package of services that includes low intensity therapy (such as physiotherapy, occupational therapy, social work) and nursing support and/or personal care. It helps older people complete their restorative process and optimise their functional capacity.  People involved in the program have a lot of input and control as to what services will best suit their needs.

Transition Care can be provided in either home like residential setting or in the community. The average duration of care is seven weeks, with a maximum duration of 12 weeks. However, this time frame in some circumstances can be extended by a further six weeks.  At BSHS there has been some terrific results achieved for people where they have successfully returned home safely and are well equipped to remain living in the community.

Our team would be happy to discuss the Transition Care Program. For any enquiries please contact our Transition Care Coordinator on 03 5349 1625.