Home at Last Program - West Neighbourhood House

cora jostiak at home in her living room
Cora Jostiak is safely settled at home after a hospital stay thanks to West Neighbourhood House. (Photo by Chris Young).

The Toronto Central Home at Last Program (“HAL”) helps older adults without immediate support arrive home safely upon discharge from the hospital.

The program arranges for a Personal Support Worker to accompany the older adult home from the hospital and helps them settle in at home. Transportation is also coordinated as part of the service, and Home at Last will follow-up with the client after they arrive home.

COVID-19 update: Home at Last is currently operating Monday to Friday, 8:30 a.m. – 6:00 p.m. The program’s referral form has been updated to include COVID-19-related questions to ensure a safe discharge. COVID-19 precautions are in place and may affect transition home or settling-in. HAL will work with hospital referral sources to strive to ensure that clients arrive home safely.

Learn more about our programming for older adults.

Essential Information

Who can access Home at Last:

Older adults aged 55 years or older who are leaving hospital emergency departments or inpatient units without support from friends or family upon discharge, and are able to direct their own care.

Where:

We provide service across Toronto, and work with Local Health Integration Networks across Ontario to coordinate HAL services outside of Toronto and provide referrals where possible. Please call 416-532-7586 ext. 142 for location-specific information.

When:

Monday to Friday, 8:30 a.m. to 6:00 p.m.

Cost:

Free

How to register:

For participants: Please ask a member of your professional care team in the hospital to complete a Home at Last referral form.

Professional care team members can access the Toronto Central Home at Last Website:

Toronto Central Home at Last

For any other questions, call 416-532-7586 ext. 142.

 

Frequently Asked Questions:

What can I expect during discharge?
A Personal Support Worker will meet you at the hospital to accompany you home and help you get settled in. Home at Last service includes Personal Support Worker and Transportation. The service is provided for up to three hours, starting from when PSW arrives at the hospital.

Is there any additional or follow-up support available?
Yes, there is: HAL 2.0 is a pilot program that offers clients additional supports for up to 12 weeks after transitioning home from the hospital. The goal is to reduce hospital readmissions.

HAL 2.0 is ideal for clients who may require:

  • Assistance to book appointments and associated transportation
  • Appointment reminders
  • Medication reminders
  • Safety checks

Please call 416-532-7586 ext. 142 for more information about HAL 2.0. The Home at Last referral form will include this service option, as well.

We also have Care Coach services. For clients who were recently hospitalized and are navigating various service options and providers, the Care Coach can help clients make their own decisions about the care and supports they need. By supporting them with providing resources and assistance with motivation, goal setting and self-determination, the Care Coach will assist with any transitional planning and offer needs-based assessments and care plans, using ‘My Story’ framework, in order to support clients’ goals and wishes.

For any other questions, call 416-532-7586 ext. 142.

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