Transitioning from hospital to home? AllThrive 365 guides you every step of the way, reducing complications and keeping you on the path to wellness.
Transitional Care
Easing The Transition from Hospital to Home
Transitioning from hospital to home can be overwhelming, especially for those facing chronic health conditions, appointment gaps, or insurance issues. Many patients are re-hospitalized within 30 days due to these challenges, but AllThrive 365’s Transitional Care Program is here to help.
Designed for under- and uninsured patients of Dignity Health Hospitals, AllThrive 365 provides one-on-one support for patients though an assigned Patient Care Advocate, access to community resources, educational materials, and available Durable Medical Equipment.
Upon enrollment, patients receive home visits to review discharge paperwork, schedule follow-ups, connect with resources, assist with prescriptions, and provide education to prevent complications.
Transitional Care is not a medical program — patients should contact their healthcare provider for medical concerns.
Our Goals:
- Improve discharge transitions through hospital coordination
- Address each patient’s unique post-hospital needs
- Connect patients with community services for long-term stability
WHAT WE OFFER
Comprehensive Support for Your Recovery
Holistic Care Coordination
From hospital enrollment to home visits and follow-ups, we provide seamless support to keep patients on track with their treatment plans.
Connection to Community Resources
We link patients to essential services like food programs, transportation, utility and rent assistance, and low-cost health clinics.
Medical Support
Our team conducts in-home evaluations to identify and address potential safety hazards for a secure recovery.
Access to Medical Records
We ensure patients receive their medical records after discharge, empowering them to manage their health.
Home Safety Assessments
Our team conducts in-home evaluations to identify and address potential safety hazards for a secure recovery.
Durable Medical Equipment
AllThrive 365 operates a comprehensive medical supply loan closet for your use.
Understanding Eligibility for Transitional Care
Service Hospitals:
- AZ General Hospital — Mesa
- AZ General Hospital — Laveen
- Chandler Regional Medical Center
- Mercy Gilbert Medical Center
- St. Joseph’s Hospital Medical Center and Internal Medicine Clinic
- St. Joseph’s Westgate
Note: Must be a Dignity Health patient within the last 90 days. These services will not replace continued treatment by a physician or other healthcare providers.
Explore Additional Transitional Care Resources
Donate Medical Supplies
Do you have good quality medical supplies or equipment to donate?
Give NowDignity Health Transitional Care
The Center for Transitional Care helps chronically ill patients upon discharge from the hospital.
Learn MoreTransitional Medical Assistance
TMA provides coverage to households receiving AHCCCS in the Caretaker Relative category.
Learn MoreTransforming Hospital-to-Home
Key to the success of transitional care is the pivotal role of Patient Care Advocates.
Learn MoreOur Partners
Contact Us
Have Questions?
We're here to help you transition safely!
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Still not sure where to start? Let AllThrive 365 help you navigate the journey!
