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Care coordinators for your hospital discharge and recovery

The Home & Community Care Transitions team works with you through recovery to make sure you’re getting the right care, in the right place, when you need it, for as long as you need it. Contact your health plan to find out if you have access to these services.

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Our care coordinators are here for you

Making sure you're ready for each step in your care journey is our commitment. A care coordinator is here to help you move to the right place for care after leaving the hospital, with the goal of getting you back home safely.

Care transition services

Our care coordinators will assist you if ongoing care in a facility is necessary. We'll guide you in understanding what to anticipate in your care journey.

Here’s how we can help:

  • Perform regular check-in visits or phone calls while you are in the facility
  • Facilitate the transition to your next site of care — whether it involves returning home, entering a skilled nursing facility, joining a rehabilitative center or moving to a longer-term care facility
  • Educate you and refer you to community resources you may be entitled to after your hospital discharge
  • Schedule follow-up appointments
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We’re here for you

Registered nurses, physical therapists, occupational therapists and speech pathologists make up our team of care coordinators. Together, we've assisted over 12 million patients in managing their personal recovery — and we're ready to assist you on the same journey.

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We’re in your neighborhood

We’re dedicated to helping older adults live more fulfilling lives. That’s why we offer our services in all 50 states.

Laura, patient’s daughter

What people are saying

"Through the care coordinators’ ongoing engagement during my mother’s stay, we were able to ease my concerns and agree upon a safe and effective transition to a more appropriate setting that could support my mother’s recovery. The transition to a long-term care facility also met her quality-of-life wishes."

Laura, patient’s daughter