Care Transitions Program

No one ever plans on going to the emergency room.

Luckily, Highland Hospital —  Alameda Health System’s flagship hospital in Oakland — is prepared for the unexpected to ensure everyone will receive care in their time of need. Each year, our Emergency Department cares for more than 110,000 patients, treating approximately 300 patients daily.CTP team

But what happens after you leave?

For many of us, we go home to our loved ones—spouses, parents, children, friends—who allow us to rest and encourage us to get well. Some aren’t so lucky to have that support system… or even a place to call home. Lacking the confidence or resources to care for themselves, these patients often face a prolonged recovery time as they may miss follow-up appointments or forget to take their medication.

Your contribution to Alameda Health System Foundation helps ensure all patients are provided a continuum of care that extends beyond the walls of our hospitals and wellness centers.

As Manager of Alameda Health System’s Care Transitions Program, I coordinate a team that works with our most vulnerable patients and connects them to resources available to assist them in our community. The Program was started by talented doctors and nurses at Highland who noticed that these patients needed extra help after leaving the hospital. Our team of social workers, nurses, pharmacists and community outreach professionals assess patients’ needs prior to leaving the hospital and visit them at home to ensure they have what they need to make a full recovery.

Stanley was one of these patients

After being badly beaten, Stanley found himself in the emergency room and hospitalized at Highland. Stanley was homeless and having a hard time finding the resources he needed to take charge of his health.

About to be released from the hospital, I met with Stanley to discuss his treatment and home care options. He didn’t have anywhere to go.

In 2013, Alameda Health System and Alameda County Health Care Services Agency partnered with Crossroads, a safe haven for patients like Stanley to recover and transition out of the hospital.

Crossroads is part of the East Oakland Community Project, whose mission is to help homeless individuals and families regain a life of self-reliance. Crossroads is a state-of-the-art emergency housing facility offering more than just a place to stay. It also teaches life skills, so individuals can advocate for themselves, and it connects them to services like career counseling and finding permanent housing.

Due to the care Stanley received at Alameda Health System and through the Care Transitions Program, he is thriving. We helped Stanley find a safe and permanent place to live, and he is closer to one of our wellness clinics and has a primary care physician he sees when needed. It has been one year since Stanley was in our care, and our services gave him the tools and encouragement he needed to prioritize his health and become confident in caring for himself.

Please consider a year-end gift to Alameda Health System Foundation. Your tax-deductible contribution will help us empower patients like Stanley to live healthier lives by supporting initiatives like the Care Transitions Program. Together, we can help all patients beyond essential medical care.

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Maia White
Manager, Care Transitions Program


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