A comprehensive approach to support successful discharge, providing patients with access to a menu of services to rebuild their strength and regain their ability to live independently.

Services include:

• Intensive Community Support Service (CSS) Care Planning - which includes weekly follow up and intensive care planning to begin within 72 hours of discharge for a period of up to four weeks.
• In addition, patients will select at least two additional services from the following menu:
  • Home at Last discharge support to assist in settling on the day of discharge (e.g. pick up prescriptions, get groceries, clean out fridge, transportation home)
  • Two free weeks of Meals on Wheels delivered to their home
  • Two free transportation rides to medical/follow up appointments within six weeks of discharge
  • Three free hours of home help/housekeeping within three weeks of discharge
  • Transitional Caregiver Supports, up to four weeks post discharge

The base bundle may include additional CSS Services as appropriate, based on the individual needs of the patient and caregiver.

At the end of the transitional period, the patient can choose to continue with selected services, however at that time regular service fees may apply.

Note: If you declined the service while in hospital but have changed your mind, eligibility for the program can be considered within three days of discharge from hospital.