- Description
- Assists clients to access Continuing Care Homes within the Edmonton Zone (Edmonton, St. Albert, Morinville, Leduc, Devon, Thorsby, Sherwood Park and Fort Saskatchewan) through standardized assessment of individual health care needs.
Helps seniors when they need to access a different level of care by:
- assessing and documenting the situation
- determining the right level of care, program, or site to meet the person's needs
- offering support and information for the person and their family regarding Continuing Care Homes
- partnering with the Community Bed Hub
What is the role of the Transition Coordinator (TC)?
The Transition Coordinator will:
- complete comprehensive client assessments to determine health care needs for continuing care services
- provide information and referrals for Continuing Care Services and/or Continuing Care Home options
- discuss and develop the transition plans with clients and their families including identified goals
- waitlist clients for appropriate Continuing Care Homes or work with Home Living to increase community supports
- assist the client and family through the transition to another health setting or supported discharge home with Home Living Case Management
- assist with connecting clients and families with other health care teams or community programs as well as recommend non-health related community services and supports
Affiliation: Acute Care, Home Living, Facility and Supportive Living, Palliative Care - Eligibility
- Yes, Based on assessed health care needs determined at the point of assessment. There is a provincial standardized assessment to access publicly funded Continuing Care Homes.
- Application Process
- Service Access: Telephone Information Line, Contact Community Care Access or Home Living Case Manager to access this service.
Referral Process: No,Self referral can be made by calling Continuing Care Access if you don't have a Home Living Case Manager. If you are already a Home Living client, your Home Living Case Manager can make a Request for Service on your behalf.
Acute care patients have access to a Transition Coordinator at all Edmonton Zone sites.
Waiting Period: Yes,An estimated wait time will be provided at the time of appointment booking.
- Telephone
- 780-496-1300 (Community Care Access)
- Fax
- 780-496-8438
- Languages
- Interpreter/Translation services - AHS Translation Services is available for Transition Coordinator assessment.
- Fees
- Fee: N/A
Fee Reduction: N/A
Membership Fee: N/A - Documents Required
Self referral can be made by calling Continuing Care Access if you don't have a Home Living Case Manager. If you are already a Home Living client, your Home Living Case Manager can make a Request for Service on your behalf.
Acute care patients have access to a Transition Coordinator at all Edmonton Zone sites.
- Accessibility
- Wheelchair access: N/A -
Other disabled access: N/A - - Topic(s)
- Agency Information
- View Agency Profile
- Last Verified On
- September 9, 2024
- Location
- Edmonton
- Hours of Operation
- Mon07:00 AM to 04:00 PMTue07:00 AM to 04:00 PMWed07:00 AM to 04:00 PMThu07:00 AM to 04:00 PMFri07:00 AM to 04:00 PM
After hours support is available from 4:00 PM - 11:45 PM Monday to Friday
Saturday and Sunday 7:00 AM - 11:45 PM
Requests for assessment can be submitted 24/7 through the CCA Call Centre.
