Transition Assistance is assistance to individuals in critical pathways, defined as times or places where people make important decisions about long-term care. It is help and understanding at a critical moment in one’s life. Help in the form of counseling regarding available community support options to help people live as independently as possible, and in homes and communities of their own choosing. Understanding in the form of a willingness to listen to each individual’s needs, circumstances, and personal preferences in helping them develop a plan to return safely and successfully to their home, to the home of a relative caregiver, or from institutional care and toward greater independence.
Individual Care Plans
Aging and Disability Resource Center (ADRC) staff will work with individuals, families, and hospital or medical social workers to help develop and coordinate an individualized community-based care plan to meet the health, safety, and social needs of older adults and individuals living with disability leaving hospital or rehabilitation care. The ADRC also works in partnership with San Benito County’s Health and Human Services Agency to help answer eligibility questions and provide application and access assistance for public programs.
Arranging for home delivered meals, assisted transportation, or personal care, as well as identifying ways to meet family caregiving and social engagement needs? The ADRC of San Benito County will help. As you plan a return home from the hospital or from long term care for yourself, or for someone you love, please contact us to find out how the support of knowledgeable ADRC staff and their network of partners can help make that return home a success!