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Nursing Home Transition and Diversion (NHTD Services)
1. Service Coordination
Our Service Coordinators work side-by-side with participants and their families to create
and carry out personalized service plans. We connect individuals to support through
waiver programs, Medicaid State Plan services, and community resources.
- For individuals leaving nursing facilities: we coordinate services needed to return
safely to the community. - For individuals at home: we help maintain health and independence to prevent
unnecessary placement.
Initial Service Coordination
Assists with waiver applications and gathering required documents.
Ongoing Service Coordination
Begins once approved. We coordinate care, ensure service delivery, and conduct
monthly face-to-face visits.
2. Independent Living Skills Training (ILST)
Supports individuals in building or maintaining daily life skills at home or in the
community.
- Focuses on personal care, home management, communication, etc.
- One-on-one services; group instruction available with approval.
3. Peer Mentoring
Connects participants with trained mentors who’ve faced similar challenges.
- Helps build confidence and self-advocacy
- Supports community reintegration
- Short-term and goal-focused
4. Positive Behavioral Interventions and Supports (PBIS)
Helps individuals with behavioral challenges that may risk their ability to remain in the
community.
Includes:
- Assessment of behavior and environment
- Individualized behavior support plan
- Family and caregiver training
- Ongoing monitoring and plan adjustments
Reach Out to Us
We’re here to help and listen.
Need support? Send us a message and let our team provide the personalized guidance and care you deserve. We’re committed to responding with compassion and clarity.
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