Elder Services of Cape Cod and the Islands was chosen as one of six Aging Services Access Points (ASAPs) across the state to receive funding from the Healey-Driscoll Administration to expand the state’s “Hospital to Home Partnership Program.” The program provides specialized expertise to hospitals to support discharges directly to a patient’s home, rather than to a skilled nursing facility or other long-term care setting.
This program has been highly successful in other parts of Massachusetts. ASAP liaisons received more than 1,800 referrals from their hospital partners in just the first eight months of the program, helping to divert nursing home placements and facilitating safe and supported discharges to patients’ homes!
“This investment in community-based care comes at a time when it is needed most,” said Health and Human Services Secretary Kate Walsh. “In addition to providing individuals with the supports they need after leaving the hospital, this program will also help open beds for other patients who require an acute level of care.”
Elder Services’ Chief Executive Officer Maryanne Ryan said “we are excited by this opportunity to strengthen our relationship with Cape Cod Healthcare. We think this program will result in better and more sustainable home care planning.” The $300,000 award will enable the agency to hire and embed a “Hospital Liaison” in both Falmouth Hospital and Cape Cod Hospital, where they will be part of the discharge planning teams. Then, when an older adult patient is discharged, the Liaison will be able to assess the person in their home to establish in home or community-based supportive services and on-going care management.
“We are committed to delivering access to high-quality care that meets patients where they are, with the right level of care at the right time,” said Cape Cod Healthcare President and CEO Michael K. Lauf. “This opportunity to build a strong community partnership with the team from Elder Services of Cape Cod and the Islands, and together close a care gap for our older adult patients who are able to discharge to their homes, will have a truly positive impact on our community. With streamlined support services in place, older patients can continue their care management in the safety and comfort of their home, and we can ensure our hospitals have capacity for those in need.”
Cape Cod Hospital has over 20,000 older adults discharged per year and this program will only provide services to a very limited number of them. However, both Cape Cod Healthcare and Elder Services see this as a positive step towards improving continuity of care for older adults in the region.
