Transition Care
The Alfred Health Transition Care Program (TCP) provides short term support and care to older people at the end of a hospital stay.
What we do
The program is designed for older people:
- who can achieve further improvements to their physical and mental abilities and are therefore able to continue living independently.
- for whom the focus will be on assisting them, while their family and carers make appropriate long-term care arrangements.
TCP can be delivered in your home or in a residential care setting. If your care needs change, you can transfer from one setting to another within a permitted timeframe. For example, you may start Transition Care in a residential care setting and then go home, and continue to receive services in your home to assist with your final recovery period.
Alfred Health delivers bed based TCP at 3 different sites:
Coppin Centre 45 Moubray Street, Melbourne, 3004
Central Park 101 Punt Road, Windsor, 3181
Hammond Care 294 Kooyong Road, Caulfield, 3162.
If you would like to view any of these sites please discuss this with your Social Worker or phone the TCP Office and ask to speak with the Manager or a TCP Senior Clinician.
Who we care for
We provide care and support for:
- people who are 65 years and over, or
- Aboriginal or Torres Strait Islanders who are 50 years and over
Who are staying in any hospital (public or private).
What to expect
Access to TCP services is usually recommended by the treating hospital team and discussed with you and your family/carers while you are still in hospital. With consent, the treating team will then refer you to TCP.
Services which may be provided include:
- case management
- medical support
- nursing services
- domestic home care
- assistance with personal hygiene
- transport support to medical appointments
- physiotherapy and other allied health support
- continence aids
- equipment, including hire costs (where the budget permits and no other means of financing exists)
- in-home respite care
It is unlikely you will need all of these services.
A TCP clinician will discuss your level of care and service needs with you to determine our ability to admit you to the program.
The services you receive and the location of those services will be based on your care needs and will be limited to the funding available.
Commonly asked questions
What is TCP?
TCP is a form of Flexible Care and is legislated under the Aged Care Act 1997. We are a jointly funded Australian and State Government program.
You can only access TCP with a valid TCP approval from the Aged Care Assessment Service (ACAS), which the treating or TCP team can arrange for you. This approval is valid for 28 days and we expect you will be offered TCP services within this time period.
There is no leave period permitted once on TCP. If you require a hospital admission you may be discharged from TCP if you cannot return within a 24 hour period. Your treating team may refer back for TCP services when you are medically stable again.
Does it cost to enter TCP?
Yes, the Australian government has set a daily fee requirement of:
- 85% of the Single Aged Care Pension for bed based TCP and
- 17.5% of the Single Aged Care Pension for community based TCP
How long can I receive TCP services?
TCP is a short-term program to assist with attaining your individual care goals. Most people stay on the program for about 6 weeks. The limit is 12 weeks.
How to access this service
Referral from your GP
Your GP or medical practitioner will organise for you to access this service.
What to bring
For an overnight (or longer) stay
- Dressing gown and slippers, or comfortable day clothes and shoes
- Personal hygiene items, such as shampoo, shaving equipment, toothpaste and deodorant
- Something to do - like a book to read, a magazine or an iPad or tablet with headphones
What not to bring for an overnight (or longer) stay
- Your handbag, wallet, purse or large amounts of cash
- Valuables, such as jewellery or watches