Returning home
Follow-up after a hospital, rehabilitation, or skilled nursing stay.
Support between providers
Bridge Care
Short-term medical care at home after a hospital stay or while you wait for ongoing primary care.
Worcester & Hampden Counties
Care during a transition
Temporary support for adults and older adults, with a plan to reconnect with ongoing care.
Between providers
Medical support while waiting for a new or established primary care provider.
Difficulty getting to care
Home visits for adults with complex needs, mobility limitations, or barriers to office visits.
Acceptance depends on clinical needs, home-visit eligibility, and available capacity.
Focused on your needs
How we can help
- Review medications and discharge instructions
- Monitor chronic conditions and changes in health
- Arrange appropriate testing and review results
- Coordinate with specialists, home health, and your primary care provider
Your next steps
From home visit to ongoing care
- Request careWe review your needs and eligibility.
- Receive short-term supportShort-term visits over 30–90 days, based on clinical need.
- Reconnect with primary careWe coordinate your transition to an ongoing provider.
Usually 30–90 days of support, based on your needs. Bridge Care does not replace your ongoing primary care provider.
Coming home after discharge?
Our 30-day Transition of Care program combines home visits, phone check-ins, medication review, and coordination with your care team.
Choose your next step
Patients & families
Call us to discuss whether Bridge Care is right for you.
Who is Bridge Care for?
- Adults needing short-term care after discharge or between providers.
- Patients in Worcester or Hampden County.
- Care needs that can be safely managed at home.
Acceptance depends on clinical needs and availability. Bridge Care does not replace your ongoing PCP or emergency, urgent, or specialty care.
Case managers & provider offices
We contact patients within 2 business days of receiving a referral.
Secure fax: (774) 366-0770
Referral criteria & what to send
Who qualifies: Adults in Worcester or Hampden County whose needs can be safely managed at home. Acceptance depends on clinical needs and availability.
- Face sheet and patient/caregiver contact details
- Discharge summary and date, if applicable
- Medication list and allergies
- Insurance information
- Reason for referral and time-sensitive concerns
- Referrer contact details and ongoing PCP
Send discharge referrals as early as possible. Visit timing depends on clinical needs and availability.
For a medical emergency, call 911. Bridge Care does not replace emergency, urgent, or specialty care.