Changing lives for the better

About

Our C.A.R.E. Program™ (Coordination, Advocacy, Resources, and Education) is a community-based transitional care service, offering specialized transitional care in San Jose, California, to patients and their family members who are affected by a life-limiting health condition. These patients and their families may still be in the process of undergoing curative treatments but still could benefit from the resources that this program provides.

Through this program, we will work with the patient and their family to provide additional resources and information to support the patient and family while they navigate this sometimes complex and complicated health care system. These resources may take the form of a medical social worker, Chaplain, or some additional medical equipment — could even be something as simple as a volunteer to come and spend a couple of hours playing a board game with you in your home. This program facilitates the collaboration between the patient, their family, and our medical team to provide relief from the stress that is associated with their health condition.

The members of our team emphasize pain and symptom management, coordinated care and communication. We treat people suffering from chronic and serious illnesses such as cancer, congestive heart failure, chronic obstructive pulmonary disease, Alzheimer’s, and kidney failure, along with other cardiac diseases. The goal is to provide an additional support system to help improve the overall quality of life for patients and their families.

What to Expect From Our Transitional C.A.R.E. Program

Our Transitional C.A.R.E. Program—standing for Coordination, Advocacy, Resources, and Education—is more than just a service. It’s a personalized support system tailored to individuals facing a life-limiting or complex health condition, especially during times of major health transitions. Whether clients are continuing curative treatments or stepping into palliative or long-term care, our team is there to make every moment count.

Seamless hospital-to-home coordination
We assist in arranging discharge planning, follow-up care, and in-home support to reduce stress for both patients and caregivers
Advocacy for patient and family needs
Our trained care coordinators speak up for patients’ preferences, ensuring that medical and emotional needs are clearly communicated to all providers
Comprehensive education and guidance
We help families understand the care process, medications, and condition management with clarity and compassion
Access to vital resources
From home health aides and skilled nursing to medical equipment referrals, we connect patients with services that promote healing and comfort at home
Improved quality of life and independence
With consistent check-ins and individualized care plans, we help patients maintain their dignity and live as independently as possible

Guiding You Through Every Transition

Navigating a serious illness or recovery period at home can be overwhelming without the right support. That’s why our Transitional C.A.R.E. Program is designed to bridge the gap between hospital care and home recovery. We work closely with patients and families to ensure the transition is smooth, compassionate, and well-supported at every step.

Frequently Asked Questions

What is a transitional care program supposed to help with?

It supports people who are moving from hospital care to home. Most programs focus on easing stress, avoiding readmissions, and helping families stay informed.

Who can benefit from a transitional care program?

People with serious or ongoing illnesses—like cancer, heart failure, or Alzheimer’s—often benefit the most, especially if they’re managing treatment at the same time.

Does transitional care include help for the family, too?

Yes, it often includes support for family members—like information, counseling, and extra hands when needed. We help make sure no one feels alone in the process.

What kind of services are usually part of transitional care?

Most programs include things like help from a social worker, emotional support, equipment needs, spiritual care, and home visits from trained team members.

How is transitional care different from hospice care?

Transitional care can start while someone is still getting curative treatment. Hospice usually begins when treatment stops and comfort becomes the main focus.