Transition of Care
Teamwork, one of our six values, drives our organization to combine our collective expertise with other service providers whose missions align with our own. Five years ago, Peninsula Family Service expanded our older adult services to include transition of care programs designed to support participants as they are discharged from the hospital and reduce re-admission rates. As coaches, we help participants realize their wellness goals, coordinate short-term meal support, transportation to doctor’s appointments, and more.
Sequoia Community Care Program (SCC): a hospital to home transitional care service provided through Dignity Health/Sequoia Hospital and a collaboration of nonprofit organizations working together. SCC serves older adults age 50 and over identified by Sequoia Hospital as needing additional support to ensure a safe transition home. SCC is offered regardless of income; however, referred clients are typically isolated, living alone and have insufficient resources to manage a successful transition.
Peninsula Circle of Care: supports older adults in their journey from leaving the hospital to achieving wellness at home, in harmony with their goals and preferences. The program is a unique partnership of patients, physicians and health care professionals, and community organizations, coordinated by Palo Alto Medical Foundation Mills-Peninsula Division, Mills-Peninsula Health Services, and Peninsula Family Service. The program is for San Mateo County residents age 65 and older who are patients of Mills-Peninsula Medical Center. Visit Mills-Peninsula’s website to learn more.
How do I apply?
Transition of Care participants are identified by staff at our partner hospitals. Those interested in joining the program should contact hospital staff for enrollment information.