Hospital to Home Transition Program
An urgent need to discharge patients from hospital beds has never been more important. Cosy Home Care works alongside hospitals, support coordinators and families to provide a safe, responsive pathway from hospital into suitable accommodation and support.
Our rapid response team helps coordinate the key supports required to transition back into the community with care, dignity and confidence.
2 Weeks Discharge Program
Our responsive discharge pathway helps reduce barriers to leaving hospital by coordinating accommodation, supports and essential planning so participants can move safely into the community.
Personalised Care Planning
We work with hospitals, support coordinators, allied health professionals and families to understand each participant's needs and build practical transition plans.
Discharge & Transition Day
On the day of discharge, our team coordinates transport, move-in support and immediate care arrangements to help participants settle safely.
Post Transition Support
Our ongoing support helps participants adjust to their new environment, stay connected with services and build confidence beyond discharge.
We Work Collaborative With Hospitals
A coordinated transition program designed around the participant, their goals and the supports needed for a safe move from hospital to home.
How We Work Alongside Hospitals
- Reduces discharge delays through early planning of care and accommodation requirements.
- Improves hospital bed availability by supporting timely patient transitions.
- Enables hospital staff to focus on patient care while we coordinate discharge arrangements.
Our Core Services Include
- Transition Planning & Coordination: We work closely with hospitals, support coordinators, families, and participants to ensure a smooth, well-planned transition from hospital to home with the right supports in place.
- Supported Independent Living (SIL): Personalised support in a safe and welcoming home environment, helping participants build daily living skills, confidence, and greater independence.
- Respite Accommodation (STA): Comfortable short-term accommodation that provides participants with quality support while giving families and carers an opportunity to take a break with peace of mind.
- Medium-Term Accommodation (MTA): Safe and supportive accommodation for participants awaiting long-term housing arrangements, ensuring stability and continued progress during the transition period.
Our Hospital to Home Journey
Approval
Cosy Home Care receives the referral and reviews the participant's discharge and accommodation needs.
Care Plan
We work with the participant, hospital team and supporters to develop a transition plan.
Staff Training & Preparation
Our team prepares the support model, routines and risk planning for safe service commencement.
Accommodation Set Up
The accommodation is prepared with the required equipment, routines and practical supports.
Allied Health Handover
Clinical and allied health recommendations are handed over and embedded into the care model.
Discharge & Transition Day
The participant transitions from hospital to their new accommodation with coordinated support.
Discharge & Transition Day and Post Transition Support
What We Do
We provide tailored Hospital to Home solutions that help NDIS participants transition safely from hospital into welcoming homes with the supports they need to live independently and thrive.
How It Helps Hospitals
A clear discharge pathway assists hospitals to reduce delayed discharge and supports safe patient flow back into the community.
Post Transition Support
After move-in, we review routines, monitor wellbeing and adjust supports so participants remain safe, stable and connected.