Nursing Home Transition (NHT) is a new program in Pennsylvania for individuals 18 years or older who currently reside in a nursing facility and would like to transition back into their home and community. This program is for those who are not scheduled to leave a nursing facility through the normal discharge process and for those who have been residing in a nursing facility and wish to return to the community. These individuals will receive support from a long-term living counselor and/or a nursing home transition coordinator. Lehigh County Aging and Adult Services coordinates NHT with 13 nursing facilities throughout Lehigh County.
The Commonwealth of Pennsylvania, through the Long Term Living Council, seeks to promote consumer choice in long term living services. This goal is accomplished by ensuring that consumers and their families or caregivers are fully informed of all options, including the full range of home and community-based services, and that they receive the guidance and support needed to make an appropriate choice.
A Long-Term Living Counselor meets with consumers soon after admission, before housing and community supports are lost. Information about resources and home and community-based services is provided. The long-term living counselor reviews formal and informal support systems available and provides education to promote an informed choice as to where and how the individual receives long term living services, in an effort to avoid unnecessary long term nursing facility placement.
The Nursing Home Transition Coordinator meets with individuals who it has been determined can safely return back into their home and community with the assistance of formal and informal support systems. The Coordinator will assist with arranging for Home and Community Based Services (HCBS) if necessary such as personal care, home modifications and transportation; may assist with obtaining housing; will provide support to family members to help them understand the services available in the community; and coordinate with the nursing facility staff and providers of service for Home and Community Based Services to facilitate consumer choice.
Long-term living counseling staff will work collaboratively and provide supportive information to nursing home staff, NHT collaborative partners, community agencies and services, and family to assure a transition is completed, or that the discharge occurs in a manner that assures consumer safety while addressing all consumer needs.
The goal of Nursing Home Transition is to educate consumers and their family members about the programs and services available in the community so they can make informed choices. Some consumers may be eligible to receive Waiver services in the community offering an alternative to receiving care in a nursing home setting. Special funding is available to help Nursing Home Transition consumers with limited financial resources pay for specified one-time transition expenses.
For additional information about Nursing Home Transition, please contact the Lehigh County Office of Aging and Adult Services at (610) 782-3034. To see a list of Nursing Home Transition Coordination Agencies please visit the PA Department of Human Services website.