Return to Community

We are here to help you successfully return to your home and community after spending time in the hospital or care facility, aiming to make your transition home as smooth as possible and reduce the chances of readmission.

The Iowa Return to Community Program provides care support planning to help eligible seniors who want to return to their community following a nursing facility or hospital stay. By coordinating wrap-around services and supports, this program supports a smooth transition and increases the individual’s ability to live safely and comfortably at home.  The goal of this initiative is to reduce chances of readmission, support increased quality of life, and ensure consumer choice.

The purposes of the Iowa Return to Your Community program are:

  • To prevent a skilled stay from becoming a long-term institutional stay, when possible.
  • To facilitate a successful transition from a skilled facility to home.
  • To assist with reducing readmission to the hospital or skilled facility.
  • To implement a person-centered plan by connecting seniors to information and assistance that they need to stay in their homes, if they so choose.

To participate in the Iowa Return to Community program, you must be:

  • Age 60 or older
  • Residing in a skilled nursing facility for rehabilitation or hospital, with the intent of returning home.
  • Able to safely return home.

The IRTC Program includes:

  • An options counselor as a resource to the skilled facility and hospital staff
  • A home visit upon discharge to review care needs
  • Weekly phone calls and/or visits for up to 90 days
  • Instruction and referrals to community resources

What are the benefits of this program?

  • You will get information and education about what options are available to you.
  • You will get help connecting to the services you need when you return home.
  • You will receive support and guidance throughout the transition process.
  • You will receive ongoing follow-up as needed to enable a safe return home.

You are eligible for this program if you:

  • Are looking to transition home from a hospital or care facility.
  • Are 60 years and older.
  • Reside in Allamakee, Black Hawk, Bremer, Buchanan, Butler, Chickasaw, Clayton, Delaware, Dubuque, Fayette, Grundy, Hardin, Howard, Jackson, Marshall, Poweshiek, Tama, or Winneshiek counties in Iowa.

Call 1-800-779-8707 for more information.