The Transitional Care Program offers services to assist with changes in health. Our goal is to help keep members active and healthy. We give support to members following a stay in the hospital or skilled nursing facility. Members have a chance to discuss their concerns with a Nurse, either by phone or through a scheduled home visit.

Our Care-ADVANTAGE Team and Nurses:

 • Help with managing medications

 • Encourage visits with primary care or specialist doctors

 • Educate about signs and symptoms and how to watch for changes in health

 • Help in keeping a Personal Health Record to share with all doctors involved in care

 • Connect with medical transportation, family support and home safety to reduce the chance of falls