Transition Check List* Two-Three Months Prior to the Move Issues: Planning Issues Task: 1) Determine scope of planning 2) Decide planning method 3) Initiate plan 4) Identify possible barriers, e.g., outstanding bills, substance abuse problems, etc. Issues: Health Task: 1) Create list of supplies and medical equipment needs 2) Complete OT evaluation and order equipment and/or seek funding Issues: Housing Task: 1) Review type of housing, location and other preferences 2) Locate housing 3) Get on waiting lists 4) List needs (furniture, supplies, etc.) 5) Begin looking for resources Issues: Transportation Task: 1) Apply for public transportation ID 2) Explore options for transportation training 3) Use public transportation Issues: Daily Living Task: 1) Determine which tasks will require assistance 2) Determine if training and therapies are needed for maximum independence Issues: Personal Finance Task: 1) Get Social Security Administration report to determine income post-discharge 2) Assess other income 3) Identify personal debts 4) Develop personal budget Issues: Social Recreation Task: 1) Begin community activities. Seek to build community relationships (e.g., places of worship, clubs, friends, etc.) 2) Consider center for independent living peer support Issues: Employment Task: Think about as a possible planning issue _________________________________________________ Transition Check List* One Month Prior to the Move Issues: Planning Issues Task: 1) Review Plan 2) Create to-do lists for yourself and your advocate 3) Start contact person/phone list Issues: Health Task: 1) Set up community doctor appointment one to three days post discharge 2) Determine source and procedure for obtaining medical supplies. Find out how soon order can be placed. Issues: Housing Task: 1) Solicit donations for needed household items and furniture 2) Start securing or arranging for others to secure items 3) Complete change of address with post office Issues: Transportation Task: 1) Make arrangements for transportation from nursing home to your home 2) Check on status of ID card Issues: Daily Living Task: 1) Determine hours of assistance required. Select care providers. 2) Contact your state's oversight agency and schedule evaluation for home help services 3) If there are any unmet equipment needs, seek funding Issues: Personal Finance Task: 1) Resolve personal debts 2) Determine money that will be required for the move and enlist help of advocate to seek community resources Issues: Social Recreation Task: 1) Continue community activities. 2) Expand to other places. Issues: Employment Task: None _________________________________________________ Transition Check List* One Week Prior to the Move Issues: Planning Issues Task: 1) Review plan and update to-do list 2) Review move schedule 3) Develop emergency contact list, copy to key people Issues: Health Task: 1) Assure timely delivery of supplies and equipment 2) If hospital bed is required, set up delivery date 3) Change address with established doctors and Medicaid/insurance company Issues: Housing Task: 1) Set up utilities and phone service 2) Notify SSA, Medicaid worker, bank, etc. of address change 3) Move belongings, if possible 4) Review and prioritize what is still needed Issues: Transportation Task: None Issues: Daily Living Task: 1) Determine personal assistant (PA) schedule. Make list of PA tasks. 2) Finalize arrangements with state PA oversight agency and providers 3) Food stamp application Issues: Personal Finance Task: 1) Notify SSA and other agencies of address change 2) Review budget 3) Set up bank account near community home Issues: Social Recreation Task: 1) Continue activities, peer support Issues: Employment Task: None ______________________________________ Transition Check List* One-Two Days Prior to the Move Issues: Planning Issues Task: 1) Make shopping list for food and personal items. Determine who will do the shopping 2) Review move schedule and update to-do list Issues: Health Task: 1) Confirm delivery of supplies, etc. 2) Select pharmacy 3) Obtain and fill prescriptions Issues: Housing Task: 1) Confirm utility and phone hook-ups 2) Buy phone, if needed. Ensure phone service is working. Issues: Transportation Task: 1) Confirm discharge transportation Issues: Daily Living Task: 1) Confirm initial visits and schedule with PAs 2) Obtain keys for PAs 3) Obtain food and personal items adequate for several days (check food banks) Issues: Personal Finance Task: 1) Set up automatic deposit for SSI/SSDI checks (800) 772-1213 (voice) Issues: Social Recreation Task: None Issues: Employment Task: None ______________________________________ Transition Check List* Day of the Move Issues: Planning Issues Task: 1) Meet at facility to review discharge instructions 2) Update to-do list Issues: Health Task: 1) Obtain discharge instructions 2) Obtain from facility medications and supplies 3) Review emergency contact list and procedures Issues: Housing Task: 1) Set up home. Involve as many support people as possible Issues: Transportation Task: None Issues: Daily Living Task: 1) Review emergency procedures and back up plan Issues: Personal Finance Task: 1) If possible, have some cash available for unforeseen expenses Issues: Social Recreation Task: 1) Meet neighbors and community support persons, as desired Issues: Employment Task: None _____________________________________________ Transition Check List* First Week After the Move Issues: Planning Issues Task: 1) Review plan and outcomes 2) Revise plans as appropriate Issues: Health Task: 1) Make appointments for medical follow-up care (dental, optical, etc.) Issues: Housing Task: 1) Resolve any housing problems with landlord Issues: Transportation Task: 1) Follow-up with transportation training. If not available, make other arrangements, e.g., peer trainer. Issues: Daily Living Task: 1) Brainstorm problem solving situations Issues: Personal Finance Task: 1) Review and adjust budget Issues: Social Recreation Task: 1) Continue community relationships and activities Issues: Employment Task: None __________________________________________ Transition Check List* First Month After the Move Issues: Planning Issues Task: 1) Review and revise plan 2) Confirm duties with other providers 3) Determine follow-up schedule (e.g., two visits/month) Issues: Health Task: 1) Review and problem-solve any health issues Issues: Housing Task: 1) Follow-up to ensure rent and utilities payments Issues: Transportation Task: 1) Follow-up on transportation issues Issues: Daily Living Task: 1) Review caregiver needs; plan for changes as appropriate Issues: Personal Finance Task: 1) Pay first month's bills 2) Review and adjust budget as needed (e.g., monthly for three to six months) Issues: Social Recreation Task: 1) Continue and expand community relationships Issues: Employment Task: 1) Investigate work and volunteer options 2) Contact Vocational Rehabilitation *Adapted with permission from "Going Home: Nursing Home Transition Services in Michigan, 1998-2002," published by the Michigan Association of Centers for Independent Living (MACIL).