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Transition Care Programme

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About the Transition Care Programme

No one wants to stay in hospital longer than they have to but sometimes we need a little more care. If you are older or have an age related condition, our Transition Care Programme can support you for up to 12 weeks when you leave hospital. The programme allows you to continue your recovery while you plan your long term care.

Your hospital discharge team will organise an Aged Care Assessment before you leave hospital. They will work out your options and together, we will create a care plan which can adapt as your needs change.

While on the programme you will have a dedicated case manager who will work with you to plan the next stage of your care. The care you receive will depend on your needs and where you receive your care.

We will also work with your health care team to make sure you get the care you need. Whether you need health or personal support, your case manager will help you navigate the system and connect with the services you need.

We can support you with:

  • Health professionals such as physiotherapists, occupational therapists and social workers
  • Personal Care (eg: showering & dressing)
  • Housekeeping and help around your home
  • Shopping
  • Meals
  • Equipment to make life easier
  • Management of appointments and travel to appointments
  • In–home respite care 

Click here to find out how you can get help through the Commonwealth Home Support Programme.

A daily fee for the Transition Care Programme is charged by the Commonwealth Government and medication costs are separate. 

*The Transition Care Programme is jointly funded by the Victorian State Government and Australian Commonwealth Government.

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Monash Health also offer a service to help Aboriginal and Torres Strait Islanders access to aged care services including:

  • Diabetes education
  • Psychologists
  • Dietitians
  • Speech Therapists
  • Support groups for elders and families

For For the Aboriginal Access Team, please contact: 9791 7747

  • Care in our home
  • Care in your home
  • For Carers
  • Referrers / professionals
  • Resources
  • FAQ

Our homes

  • Allambee Nursing Home
  • Chestnut Gardens
  • Mooraleigh Hostel
  • Yarraman Nursing Home

Our services

  • Physiotherapy
  • Podiatry
  • Occupational Therapy
  • Exercise Physiology
  • Nursing
  • Speech Pathology
  • Dietetics
  • Dementia Care
  • Social Work
  • Respite Care

Our services

  • Activity and Therapy Groups
  • Healthy Bodies
  • Healthy Minds
  • Healthy Relationships
  • Healthy and Independent
  • Staying Behind the Wheel
  • Housekeeping
  • Personal Care
  • Meals
  • Gardening

Our services

  • Home Maintenance
  • Equipment
  • Community Events
  • Social Activities
  • Shopping
  • Transport to Appointments
  • Transition Care Programme

Please note that the type and amount of services we can offer may be limited by any funding you receive such as Home Care Packages, Commonwealth Home Support Packages (CHSP), National Disability Insurance Scheme (NDIS) or Linkages packages. Extra services can be added for additional fees.

Monash Specialised Living Options also welcomes self-funded clients.

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Get in Touch

Questions about care in your home (Home Care Packages): 9792 7788

Questions about care in our home or residential care home tours: 9792 7799

For Commonwealth Home Support Program appointments, please call: 03 857 25631

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