Community Care Transitions Program Stories

Access to reliable transportation is a major concern for many seniors, who can often find it difficult to attend medical appointments. Here’s how a visit from a care transitions coach helped one senior solve the problem.
Shamael, one of Partners’ care … Read More

Magda* was born and raised in Transylvania, Romania. Eighteen years ago, at the age of 70, she moved to the US to be near her family. Magda had always enjoyed good health until, in August 2014, she was diagnosed with an intestinal tumor. The news was devastating for … Read More

Daniel Dominguez, who received care transitions coaching following his release from UCLA Medical Center, wrote to Partners CEO, June Simmons, to express his gratitude for the services he received. It sure did … Read More

Coach Jesus had to educate patient Antonio about his doctor’s rightful role in his ongoing health. He assumed doctors were only there for illness, not wellness. The first step was switching to a … Read More

A Bodfish, CA resident gave Coach Ida a run for her care transition money. In his 60s with multiple chronic conditions and recovering from addiction, he needed post‐discharge food, transportation and legal aid. … Read More

Margarite was grateful for the visit from her coach, Adrine, and her encouragement and guidance on following up with the doctor. She had not planned to do so, but because Adrine helped her … Read More

Before hospitalization, Mabel had been in charge of her own medications. But after discharge, her escalating confusion concerned her family, so they concentrated the coaching session on medication reconciliation. In that process, Mabel’s … Read More

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