Transition Care Program

What is the Transition Care Program?

The Transition Care Program provides a range of short-term care services to eligible older people following a hospital stay to help them regain as much independence as possible.

Services include therapy, nursing support and /or personal care that will help eligible older people regain as much independence as possible and assist them in making long term care and support arrangements.

The program is jointly funded by the Australian Government and the South Australian Government to provide older people with short term assistance following a hospital stay.

Fact sheets

Introduction to the Transition Care Program (PDF 87KB)

Information for older Aboriginal people (PDF 142KB)

Information for older culturally and linguistically diverse people (PDF 86KB)

Fact sheets in languages other than English

How does the Transition Care Program work?

Services are provided for up to a 12 week period with the aim to optimise the function of the eligible patient and can be provided in selected residential care beds or in the person’s home (or a combination of both).

The program also provides dedicated resources for short term therapy and support to assist older people achieve their best health outcomes. This can be a combination of a range of care services and could, for example, include:

  • nursing
  • physiotherapy
  • occupational therapy
  • speech therapy
  • social work
  • dietary advice.

Care is provided either in the person’s own home or a home-like environment within a residential setting such as an aged care home or similar facility.

Who is eligible for the program?

An older person is eligible for the Transition Care program if they are:

  • in hospital and nearing the end of their hospital stay
  • able to benefit from a program that can help improve recovery and restore independence as much as possible.
  • have been assessed by and Aged Care Assessment Team (ACAT) as being eligible, and wish to be part of the Transition Care Program.

To be eligible, the older person must be in hospital and have an ACAT assessment approving them to access the program. Each person receives an individualised package of care that addresses areas of concern as identified by the person or their carer.

Eligibility and assessment fact sheet (PDF 109KB)

Further information

If you would like more information about the Transition Care Program in your area please contact:

Adelaide metropolitan

  • Southern Transition Care Team
    Telephone: (08) 8204 7640
    Fax: (08) 8204 4627
  • Central Transition Care Program
    Telephone: (08) 8222 8864
    Fax: 1300 724 900
  • Northern Transition Care Program
    Telephone: (08) 7321 4066
    Fax: (08) 7321 4081

Country Health SA

Country Referral Unit
Address: 14 Scholz Avenue, Nuriootpa
Postal: PO Box 858, Nuriootpa SA 5355
Telephone: (08) 8561 2186
Fax: (08) 8561 2128