Health Plan of San Mateo, located in the San Francisco Bay Area, developed the “Community Care Settings” pilot program in an effort to help residents of a skilled nursing facility transition back into the community and live at home. The health plan partnered with Brilliant Corners and the Institute of Aging to coordinate housing, medical and behavioral health care, home health, adult day care, and transportation, and other social needs.
To date, the plan has helped nearly 200 of its Medicare Advantage members transition from nursing facilities to homes in the community.
CONRADO: From Immobility to a Full, Rich Life
Conrado had hip replacement surgery in 2012, which left him unable to walk. The following year, he was put on dialysis for kidney failure. Conrado’s health problems left him unable to pay his mortgage; his house went into foreclosure. After long-term care at a nursing home improved his health, Conrado’s doctor recommended him for the Community Care Settings program.
Through the program, Conrado was able to move to a furnished apartment in December 2015. His CCSP Care Manager visited weekly and collaborated closely with everyone from his children to his care team to building management to assure his needs were met.
Learn more here:
Conrado’s Story (Health Plan of San Mateo)
Health and housing gap for seniors is far larger, more expensive than we think (The Hill, op-ed)