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Transition Care Program
The Transition Care Program aims to help you improve your independence and confidence after a hospital stay. It provides a package of services including low intensity therapy (more information) and personal and/or nursing care as part of an ongoing but slower recovery process. This means that you and your family or carer have time to consider your long-term care arrangements, which may include returning home with community support or accessing the level of care provided by an aged care home.
Transition care is provided in your own home or in a ‘live-in’ setting (more information).
Transition care can be provided for a period of up to 12 weeks, with a possibility to extend to 18 weeks if you are assessed as needing an extra period of therapeutic care. The average period of care is expected to be about eight weeks.
Once the program is fully established, we expect that it will assist up to 13 000 older Australians each year.
- Eligibility
- Services provided
- Where does transition care take place?
- Care fees
- Your rights
- Quality of care
- Do you want to make a complaint?
Eligibility
To be eligible for transition care, you must be an older person and an in-patient of a hospital. You must have completed your acute and any necessary sub-acute care (eg rehabilitation).While you are still in hospital, you must be assessed by an Aged Care Assessment Team (ACAT, or ACAS in Victoria) (more information) as someone who would be suitable for transition care. This includes consideration of your ability to benefit from the services transition care offers (eg low intensity therapy such as physiotherapy (more information) and occupational therapy (more information)) within the allowable time limits (a maximum of 12 weeks, with a possibility to extend to 18 weeks if you are assessed as needing an extra period of therapeutic care).
Next step: Aged Care Assessment Team Finder
Services provided
Transition care provides a package of services tailored to your needs. This may include a range of low intensity therapy services and nursing support and/or personal care services.Examples of low intensity therapy services may include:
- physiotherapy
- occupational therapy
- dietetics
- podiatry (more information)
- speech therapy (more information)
- counselling, and
- social work.
- showering, dressing
- eating and eating aids
- managing incontinence
- transport to appointments
- moving, walking, and
- communication.
Where does transition care take place?
Transition care can take place either at home or in a live-in setting. When it’s offered in a live-in setting, it must be provided in a more home-like, non-hospital environment that has space available for therapy.Care fees
A transition care provider may charge you a fee as a contribution to the cost of your care. The maximum fee is 85% of the basic daily rate of a single pension for care delivered in a live-in setting or 17.5% of the basic daily rate of single pension for care delivered at home.Access to transition care is decided on a needs basis, not on your ability to pay fees. In determining your ability to pay fees, your transition care provider takes into account your other unavoidable expenses such as high pharmaceutical bills or fees that you still need to pay to your aged care home.
Your rights
While you’re in transition care you have rights, including the right to have a Transition Care Recipient Agreement with the service provider. You also have the right to:- full and effective use of your personal, civil, legal and consumer rights
- be in a safe, secure and homelike environment
- be given enough information to make an informed choice about your care
- have written information about your rights, care, accommodation and any other information that relates to you personally
- be involved in deciding on and choosing the care most appropriate to your needs
- receive care that takes account of your lifestyle, cultural, linguistic and religious preferences
- be given a written plan of the services you’ll receive
- take part in social activities and community life as far as possible
- have your dignity and privacy respected
- complain about the care you’re receiving, including the manner in which it’s being provided, without fear of losing the care or being disadvantaged in any other way, and
- choose a person to speak on your behalf for any purpose.
Quality of care
It’s also good to know that the government has a quality framework in place to monitor:- the quality of transition care you receive
- the qualifications of staff
- the building where transition care takes place
- the complaints procedure, and
- your rights.
Do you want to make a complaint?
If you have any concerns about your care, it’s often best to raise them, in the first instance, with your transition care service provider. However, if you’re unable to resolve the issue or prefer not to complain directly to your service provider, you may wish to contact your state or territory health services’ complaints body or the Aged Care Complaints Investigation Scheme.The Aged Care Complaints Investigation Scheme is a free service that seeks to resolve your complaints about your health, safety and/or welfare – and it’s available to your relatives, guardians or representatives as well.
Also, in each state and territory an aged care advocacy service can help you understand the information you’re given and speak to your service provider on your behalf.
Read more: Making a complaint
Common questions on this topic:
- What happens if my doctor does not agree with the ACAT assessment?
- If I'm receiving transition care will I have to contribute to the daily cost?
- Where will the transition care be provided?
See more common questions on this topic | See all common questions
