Patients can transition from hospital to home with TARCOG initiative

MADISON – Imagine the shock that a hospitalized patient faces with a prognosis for long-term care upon returning home. How can the patient receive vital help for the daily routine?

The Top of Alabama Regional Council of Governments or TARCOG offers a program that can help the patient return home with Medicaid Waiver services instantly upon discharge.

“The appropriately named ‘Hospital to Home’ program starts with a referral,” Melissa Brinkley said. Brinkley works as Medicaid Waiver Program Manager for TARCOG. Hospital social workers, discharge planners or case managers in social services work with a patient to take the first step toward a safe transition.

Hospital to Home uses an expedited application process to initiate services immediately, Brinkley said.

Another key employee is Kelley Carpenter, who works as Transition Coordinator for the Hospital to Home program. If a patient receives a referral, Carpenter goes to the hospital to meet with the patient to determine eligibility and begin the transition process.

To qualify for Hospital to Home, a patient must meet certain requirements: * The patient must have eligible status for Medicaid.

* The patient must have medical eligibility for long-term care.

* The patient’s home must present a safe and suitable environment.

* The patient may require a willing and able caregiver.

Based on development of a care plan, a person may receive assistance for several scenarios: * Homemaker services — Housekeeping, laundry, grocery shopping and errands are examples.

* Personal care needs — Bathing, dressing and grooming assistance are examples.

* Food – Meals are delivered weekly to the patient’s home.

* Medical supplies — Incontinence supplies, wet wipes and linen savers are examples.

* Emergencies – The patient may need a Personal Emergency Response System or PERS.

Two Medicaid waivers are utilized for the Hospital to Home program, Brinkley said.

The Alabama Community Transition or ACT Waiver (traditional) serves people with disabilities or long-term care illnesses who currently reside in an institution and who want to transition to the home or community setting.

The Elderly and Disabled or E&D Waiver serves individuals who are elderly, disabled or both. This provision accommodates a person who could live independently, or alone, at home with some additional assistance that the waiver provides.

TARCOG serves DeKalb, Jackson, Limestone, Madison and Marshall counties in North Alabama. For more information, visit call 256-8300818, or visit tarcog.us.