Community Transition Liaison Program (CTLP)
The Community Transition Liaison Program (CTLP) is designed to support residents in navigating the often-complex process of transitioning from a Nursing Facility (NF), back to the community.
Central Boston Elder Services
Welcome to the Community Transition Liaison Program (CTLP)
At Central Boston Elder Services, we know that moving from a skilled nursing facility (SNF) back into the community can be daunting. That’s why our Community Transition Liaison Program (CTLP) is here to guide you through every step of the process.
Our CTLP provides a dedicated Community Transition Liaison (CTL) who is on-site at your skilled nursing facility regularly, to assist with your transition.
Our CTLP team will:
- Engage with residents who are in the nursing facility to understand if they are interested in returning to the community.
- Provide assistance and coordination with discharge planning.
- Connect residents to state programs and local community supports.
- Assist the resident in mitigating issues that may impact their ability to successfully transfer to the community.
- Serve as the main point of contact for residents, families, and nursing facility staff to ensure a smooth transition.
- Collaborate with nursing facility staff on discharge planning.
- Engage in discussions with residents and families to explain your options and help create a personalized transition plan.
- Identify and address any obstacles to returning home.
- Coordinate referrals and follow-ups with state programs and community resources to support you at home.
- Help complete necessary paperwork for housing, SNAP, MassHealth, and other essential programs.
Successfully transitioning from a skilled nursing facility to home requires careful planning and knowledge of available resources. The CTLP is here to help you make informed decisions about long-term services and supports (LTSS) for a seamless transition back home.
Eligibility and Cost
We are proud to offer CTLP services at no cost to all nursing facility (NF) residents aged 22 and older, regardless of the insurance type, and whose NF stay exceeds 45 days or is less than 45 days and has requested assistance with transition to the community.
Your well-being is our top priority, and we are here to provide the support you need.
Additional Resources:
To learn more about enrolling in the Community Transition Liaison Program (CTLP), please contact your local Aging Services Access Point (ASAP) Aging Services Network | Mass.gov .
For more information, please refer to the Nursing Facility Bulletin 179: Community Transition Liaison Program. 2023 MassHealth provider bulletins | Mass.gov
Our friendly CBES staff members are also available to answer any questions you may have. We are here to help!
