Post Acute Care (PAC)

We care for people being discharged from hospital (including the emergency department, urgent care, acute, and sub-acute services) who have limited support at home.  

You will need to be assessed as requiring short-term (28 days from date of discharge), community-based support to assist you in recovering in the community.  

We provide a range of services and support tailored to individual needs. The program aims to help people recover and return to a normal lifestyle as soon as possible, and to avoid any unplanned return to hospital. Our goal is for your safe and timely discharge. 

 
How the program works 

If you are identified as needing PAC services, your Care Coordinator will: 

• visit you in hospital before discharge OR call you after discharge to discuss your needs 
• arrange required services through contracted providers if available 
• liaise with community service agencies involved in your care 
• monitor your service and care needs by regular phone contact with you, your family, and any involved agencies 
• liaise with agencies that can provide longer-term services 
• make referrals to other community agencies if needed. 

Services include: 

• personal care (shower assistance) 
• home help (domestic assistance) 
• shopping assistance 
• nursing care 

• Referrals are accepted from your hospital care team. The PAC referral will occur when you are being discharged from hospital.
• If another program was providing support before your hospital stay, these services should resume upon discharge.