What is the Transition Care Program (TCP)?
The Transition Care Program (TCP) is an initiative of the Commonwealth Department of Health & Ageing in collaboration
with the Victorian Department of Human Services.
The Western Health Transition Care Program aims to provide
short-term support and active management for older people
who have completed their acute and sub acute episode of
care and who are moving from the acute/sub-acute sector into residential care or supported care in the community. Western
Health TCP provides goal oriented, time limited care for people
who require extra time to complete their restorative process,
optimise functional capacity and finalise & access long-term
care arrangements. TCP is not a substitute for other programs
such as Rehabilitation, GEM, Community Based Rehabilitation.
Transition Care may be provided either in the home
(Community-Based Transition Care), or bed based (Bed-
Based Transition Care). Western Health has 15 Community
Based TCP packages and 15 Bed Based TCP packages.
The Bed Based packages are based at The Williamstown
Hospital's Lower West Ward.
Transition Care can be provided for 12 weeks however the
average duration of care is expected to be 8 weeks.
For more information about the Transition Care program, you
can visit the national website at http://www.health.gov.au/ageing-transition-care
Who is eligible?
To be eligible for Western Health TCP clients must live within
the 5 municipalities of the west (Brimbank, Hobson's Bay,
Maribyrnong, Melton, Wyndham).
In general, to be eligible for Transition Care, an older person
will have:
- Completed his/her acute and sub-acute episode of
care, be medically stable and ready for discharge, as
assessed and agreed by the treating unit, and
ACCS/Geriatrician. Therefore only those currently in
hospital are eligible to enter the program.
NB: There should be no outstanding investigations or
procedures requiring inpatient management, or that
might substantially alter the patient's management plan. - Been assessed by the ACAS as eligible to receive
permanent residential aged care at least at the low level
of care if he/she applied for residential aged care, and
also be approved for Flexible Care (Transition Care) on
the 3020. - Been assessed by ACAS as being able to benefit from
a period of care in a non-hospital environment to:
· Access low intensity therapy and functional
maintenance, such as physiotherapy, occupational
therapy and social work as part of an ongoing but
slower recovery process; and/or
· Assess their circumstances, together with their carers
and families, and identify and consider the care options available to them; and/or
· Explore their preferred aged care option, including
whether they can return to the community. - Consented to access Transition Care.