Care Transitions
Care Transitions helps older adults successfully transition from the hospital or skilled nursing facility to home through coaching from a COA care manager.
A care manager schedules a home visit and three follow-up phone calls with clients for no cost to:
- Better understand and manage medications
- Make follow-up appointments with primary care physician and specialists
- Respond to warning signs that could mean the client’s condition is worsening
- Create a Personal Health Record that includes information to take to medical appointments
- Make connections to community resources that help the client maintain their health and independence
Care Transitions is appropriate for those who do not require the in-home services available through FastTrack Home, but who would benefit from guidance to help with a successful recovery at home.
Eligibility for Services
- Age 60+
- Butler, Clermont, Clinton, Hamilton or Warren County resident
- Discharging from a hospital or skilled nursing facility