Transition Care Services (South West Country) circle-tcs

St Ives Home Care offers intensive short term packages in the south west country area of Western Australia to those looking to return home after a stay in hospital. St Ives Home Care is the only Government approved provider of these services in this region.

Transition Care Services (TCS) aims to rehabilitate seniors after they have had a stay in hospital, for a period of up to 12 weeks (extensions available for up to 6 weeks with further approval from an Aged Care Assessment Team).

These short term packages seek to optimise the independence and functioning of people returning home after a stay in hospital. Support is provided through a variety of services focused on therapy and is case managed by a registered nurse from St Ives Home Care.

Services may include:

  • equipment to help you with movement around your home
  • continence aids
  • low-intensity therapies such as physiotherapy, speech therapy, dietetics and occupational therapy
    nursing support, and
  • personal, domestic and social support

The highly successful Transition Care Services program is different from a normal package of care in that it is therapy and goal focused, often seeing a full recovery in a short time-frame.

According to 2012 St Ives Home Care figures, based on the Modified Barthel Index measuring physical ability:

“95% of those leaving the program experienced a marked improvement in their general functioning, with 71% of St Ives Home Care clients no longer requiring formal services.”

The Transition Care Services program is funded by the Western Australia Department of Health.

Next steps

You will need an ACAT assessment and an assessment by St Ives Home Care. The hospital staff will coordinate these assessments with you before you leave hospital.

If you are planning ahead for a hospital visit, please speak to your GP or telephone St Ives Home Care for more information about Transition Care Services on 1300 20 20 03 or email us