Nursing Home Transition Financing Programs

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    Programs that are designed to assist institutionalized residents, or those about to be discharged from a hospital to a nursing home, to return to the community to live in a less restrictive setting. Some transition programs are funded using Medicaid and therefore require that eligible participants be Medicaid recipients. Other programs have been created using state or local funds. The programs typically provide case management and, unless other funding sources are available, provide funding for and link program participants to existing home and community based services, home modification programs, assistive technology equipment, assisted living facilities or other supported housing options and/or other needed services.

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    There are 23 matching records.
    Service NameDescriptionLocationProgramAgency
    Benefits Data Trust - PACE Application CenterProvides assistance over the phone for older and disabled Pennsylvanians to complete applications for PACE/PACENET.PhiladelphiaBenefits Data Trust - Benefits AssistanceBenefits Data Trust
    Carbon County Area Agency on AgingArea Agencies on Aging provide local services, act as advocates, and generally assist older citizens to remain active in their communities. They operate under guidance from the Pennsylvania Department of Aging. Services include: - Senior Centers and other activities - Legal Assistance - Benefit Counseling/Assistance with applications - Volunteer Opportunities - Ombudsman Services - Pre-admission Assessment - Transportation - Provides Caregiver Support Program - Provides daily hands-on care - Protective Services for older adults to investigate reports of abuse, neglect, exploitation or abandonment and services to reduce risk for incapacitated persons. - Senior Farmer's Market Program distributes free vouchers for residents age 60 or older that meet income guidelines Core services offered after a clinical evaluation: - In-home services - In-home meals - Care/Case management - Consumer reimbursement - Adult Day Care - Personal Emergency Response System - Personal Care services Information and referral service provides information on the availability of services and programs for older adults. Services may be delivered directly, purchased from a community agency, or available through a cooperative agreement. CarbonCarbon County Area Agency on AgingCarbon County Area Agency on Aging
    Care-Managed Services-Columbia Montour Aging OfficePrior to receiving any in-home service an older adult must be assessed by the care management staff. Each referred person will be visited in their own living environment where an in-depth interview will take place. All mandated forms must be completed before services begin. As a result of the assessment process, some individuals can remain at home with a range of services that vary from minimal supportive services to intensive in-home services.ColumbiaCasework ServicesColumbia-Montour Aging Office
    Care-Managed Services-Columbia Montour Aging OfficePrior to receiving any in-home service an older adult must be assessed by the care management staff. Each referred person will be visited in their own living environment where an in-depth interview will take place. All mandated forms must be completed before services begin. As a result of the assessment process, some individuals can remain at home with a range of services that vary from minimal supportive services to intensive in-home services.MontourCasework ServicesColumbia-Montour Aging Office
    Chester County Health Department - Nursing Home Transition FinancingThe Nursing Home Transition Services program provides coordinated resources and services for adults to live independently in the community. NHT (Nursing Home Transition) services promote individual choice in long term living options. The agency serves as the facilitator of NHT services for individuals with disabilities under the age of 60 and has a collaborative relationship with the Chester County Office of Aging for long term living services. Transitions Services can include: - Counseling - Relocation Assistance - Educational information - Networking with community resources to facilitate consumer choices - Enrollment in (CSPPPD) Community Service Program for Persons with Physical Disabilities Waivers - Community OptionsChester*Main Site (The Cerebral Palsy Association of Chester County)Cerebral Palsy Association of Chester County
    Lehigh County Office of Aging and Adult ServicesCommitted to supporting and empowering the well being of adults of all ages, residing in Lehigh County. Information and assistance is provided to enable individuals to remain active, healthy, productive and independent in their community. Senior Services include: - Apprise - Adult day care - Aging waiver program - Assessment - Care Management - Caregiver Support Program - Cedarview Apartments - Health and Wellness - Homemaker/home support (18-59 years of age) - Home modification - Housing case management/housing assistance - Information and assistance - Neighborhood senior centers - Nursing Home Transition - PA LINK to Aging and Disability Resources (www.lehighnorthamptonlink.org) - Ombudsman program - Personal care - Protective services - Transportation Click here to find information on subsidized housing, home health care, personal care homes, nursing homes, retirement communities, etc.LehighLehigh County Office of Aging and Adult ServicesLehigh County Office of Aging and Adult Services
    Montgomery County Office of Senior Services - Nursing Home Transition Program (NHT)Nursing Home Transition (NHT) provides people with the help they need to move back to the community and then provides services to them so that they can live comfortably and safely. NHT staff will visit nursing homes to identify those people who want to move to the community. Services Include: - Finding housing - Making your home accessible - Planning your move - Personal assistance (attendant care) services - Service coordination - Transportation - Training and other services based upon your needsMontgomeryMontgomery County Office of Senior Services - Montgomery; NorristownMontgomery County Office of Senior Services
    Montgomery County Office of Senior Services - Nursing Home Transition Program (NHT) - North PennNursing Home Transition (NHT) provides people with the help they need to move back to the community and then provides services to them so that they can live comfortably and safely. NHT staff will visit nursing homes to identify those people who want to move to the community. Services Include: - Finding housing - Making your home accessible - Planning your move - Personal assistance (attendant care) services - Service coordination - Transportation - Training and other services based upon your needsMontgomeryNorth Penn District OfficeMontgomery County Office of Senior Services
    Montgomery County Office of Senior Services - Nursing Home Transition Program (NHT) - PottstownNursing Home Transition (NHT) provides people with the help they need to move back to the community and then provides services to them so that they can live comfortably and safely. NHT staff will visit nursing homes to identify those people who want to move to the community. Services Include: - Finding housing - Making your home accessible - Planning your move - Personal assistance (attendant care) services - Service coordination - Transportation - Training and other services based upon your needsMontgomeryPottstown District OfficeMontgomery County Office of Senior Services
    Montgomery County Office of Senior Services - Nursing Home Transition Program (NHT) - Willow GroveNursing Home Transition (NHT) provides people with the help they need to move back to the community and then provides services to them so that they can live comfortably and safely. NHT staff will visit nursing homes to identify those people who want to move to the community. Services Include: - Finding housing - Making your home accessible - Planning your move - Personal assistance (attendant care) services - Service coordination - Transportation - Training and other services based upon your needsMontgomeryWillow Grove District OfficeMontgomery County Office of Senior Services
    Northampton County Area Agency On AgingArea Agencies on Aging provide local services, act as advocates, and generally assist older citizens to remain active in their communities. They operate under guidance from the Pennsylvania Department of Aging. Services include: - Advocacy - Support and representation, administratively and legislatively, for the needs of older adults as a group or individually. - APPRISE - assistance with health insurance benefit concerns, appeals, benefit applications. - Employment Services - subsidized employment for training purposes. Available to low income persons age 55 and older. - Information and Referral - answers to questions on the availability of services and programs for older adults. - Legal Services - provided in non-fee generating cases via a contract with North Penn Legal Services, Inc. - Nursing Home Transition - Information about availability of long term care in a variety of settings - in the home, or in assisted living, and planning/coordination in making a move to an alternate setting including arranging for necessary services, for current residents of nursing homes. - Ombudsman - receives, investigates and assists in resolving complaints about quality of long term care. Provides information on long term care issues. - Protective Services - activities, resources and supports to prevent or intervene in abuse, neglect, exploitation and abandonment cases. - Specialized Transportation - limited availability of rides to medical appointments and social service agencies. - Care Management - casework services for assessment and care planning, and authorization of the following: - Adult Day Care - caregiving in an organized setting for less than a 24 hour day. Excellent for caregiver respite. - Emergency Energy Assistance - bill payment or provision of fuel to avoid utility shut off or lack of fuel in crisis situations. - Caregiver Support Program - educational services and financial assistance to family care providers. - Home Delivered Meals - hot/cold meals delivered to maintain necessary nutrition. - Home Health Care - skilled nursing, therapy and aide services. - Nursing Home Respite Services - respite for overnight absences of caregivers. - Personal Care - in-home help with bathing and other personal hygiene, laundry, shopping and meal preparation. - Pre-Admission Assessment - level of care determination for those considering admission to a long term care facility. - Waiver Services - Medicaid-funded in-home services of the types listed above, and more, to maintain nursing-home eligible older adults in their homes. - Senior Farmer Market Nutrition Program - provides food vouchers for residents 60 years old who meet income guidelines Information and referral service provides information on the availability of services and programs for older adults. Services may be delivered directly, purchased from a community agency, or available through a cooperative agreement. Emergency oil delivery may be available to County residents, 60 or older, who have submitted a LIHEAP application and have 1/8 of a tank of oil or less. Call 610-559-3270 for information. Satellite Office: 87 Bangor Junction Road, Bangor, PA 18013 800-446-0094 or 610-588-7200 Click here for Housing Resources for Older Adults Click here for Senior ServicesNorthamptonNorthampton County Area Agency On AgingNorthampton County Area Agency On Aging
    Nursing Home TransitionProvided for consumers who want to return to their home. NHT helps to identify these consumers and provide help to reduce barriers such as finding housing, coordinating service needs, and financial assistance for expenses relating to a transition from a nursing facility to home.MifflinMJAAA ServicesMifflin Juniata Area Agency on Aging
    Nursing Home Transition-Area Agency on Aging for Luzerne and Wyoming CountiesThe Nursing Home Transition Program serves nursing home residents age 18 or older living in Luzerne/Wyoming Counties. A Transition Coordinator is available to visit residents who have expressed a desire to return to the community. The Transition Coordinator gathers information about community resources and collaborates with a Transition Team chosen by the resident.LuzerneArea Agency on Aging-Luzerne and Wyoming CountiesArea Agency on Aging-Luzerne and Wyoming Counties
    Nursing Home Transition-Columbia Montour Aging OfficeProvides an opportunity for some individuals currently residing in nursing facilities to move back into the community. Assistance is available for securing housing, furnishings, the actual move, and coordinating needed services. Funds for this program come from both the Department of Public Welfare and the Department of Aging.ColumbiaCasework ServicesColumbia-Montour Aging Office
    Nursing Home Transition-Columbia Montour Aging OfficeProvides an opportunity for some individuals currently residing in nursing facilities to move back into the community. Assistance is available for securing housing, furnishings, the actual move, and coordinating needed services. Funds for this program come from both the Department of Public Welfare and the Department of Aging.MontourCasework ServicesColumbia-Montour Aging Office
    Nursing Home Transition Program-Area Agency on Aging-Lackawanna County Department of Human ServicesRegardless of age, if you or someone you love resides in a nursing facility and would like to return home, support exists that can make that happen. Either the AAA or the Northeast PA Center for Independent Living can provide information about additional resources that can be used to pay for the necessary expenses to help you move back into the community and if necessary to help arrange for home and community based services to support you during and after your transition. LackawannaArea Agency on Aging-Lackawanna CountyLackawanna County Department of Human Services
    Nursing Home Transition Services - Roads to Freedom Center for Independent Living of North Central PANursing Home Transition provides alternatives to nursing home care to individuals’ ranging from 18 to 59 years of age by providing opportunity for individuals and their families or caregivers to be fully informed of all long-term living options, including the full range of home and community-based services. Participants receive the guidance and support needed to make an informed choice about their long-term living services empowering consumers who want to move to a home and community of their choice.ClintonRoads to Freedom - Independent Living ProgramRoads to Freedom Center for Independent Living of North Central PA
    Nursing Home Transition - Wayne County Area Agency on AgingProvides the opportunity for individuals and their families or caregivers to be fully informed of all long-term living options, including the full range of home and community based services, and to ensure that they receive the guidance and support needed to make an informed choice about their long-term living services. The program assists individuals in moving out of the institutions and eliminates barriers in service systems so that individuals receive services and supports in settings of their choice. WayneWayne County Area Agency on AgingWayne County Area Agency on Aging
    PDA Waiver ProgramThis program provides home and community based long-term care services to individuals as an alternative to nursing home placement. Services are funded through a special federal waiver, which allows Medicaid payments typically used for nursing home care to be used for home care services.MifflinMJAAA ServicesMifflin Juniata Area Agency on Aging
    Roads to Freedom - Nursing Home Transition ServicesNursing Home Transition provides alternatives to nursing home care to individuals’ ranging from 18 to 59 years of age by providing opportunity for individuals and their families or caregivers to be fully informed of all long-term living options, including the full range of home and community-based services. Participants receive the guidance and support needed to make an informed choice about their long-term living services empowering consumers who want to move to a home and community of their choice.LycomingRoads to Freedom - Home and Community Based Waiver ProgramRoads to Freedom Center for Independent Living of North Central PA
    STEP, Inc - Nursing Diversion Aging Waiver Lycoming County Office of AgingWaiver recipients are provided care in the community; appropriate for those who would otherwise be eligible for nursing home care. Applicants will be assessed to check if sufficient formal and informal services and supports can be developed and implemented so as to safely and adequately meet the person’s needs. There are financial eligibility requirements for participation in this program.LycomingSTEP, Inc. - Independent Living PathwaySTEP, Inc.
    Supports Coordination of NWPA - Supports CoordinationProvides assistance as necessary in order for individuals to remain in their homes.ErieSupports Coordination of NWPASupports Coordination of NWPA
    YCAAA, Aging Waiver ProgramProvides long-term care services to qualified older Pennsylvanians living in their homes and communities. ELIGIBILITY: Must be 60 or older; be assessed as nursing facility clinically eligible (NFCE) as determined by the current assessment process; and meet financial eligibility requirements for participation in the MA program, income limit is $2,199/month (2017) and asset limit is $8,000 for a single person and $29,000.00 for a married couple. • Statewide Elder Abuse HOTLINE: 1-800-490-8505 •YorkYork County Area Agency on Aging (YCAAA)York County Human Services Department, York County Government, YCHSD

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