Hospital to Home Transitions

When someone has Alzheimer’s disease or a related dementia, his/her ability to provide care for him/herself becomes limited.  As the disease progresses, the person will become increasingly dependent on others to manage care at home. Caregivers play a significant role in helping provide care and minimizing unnecessary hospitalizations and readmissions.

The Care Transitions Notebook: Caring for Someone with Memory Loss or Alzheimer’s After a Hospitalization has been specifically created to help caregivers better understand Alzheimer’s disease and related dementias and how to care for someone after a hospitalization. The Notebook places particular emphasis on mid-stage Alzheimer’s disease; however, content may be relevant to people in various stages of the disease process.

Notebooks can be downloaded free of charge:

The Coaches training and facilitator guides assist providers as they work with caregivers:

Project Replication

Materials are available for use with permission from Alzheimer’s Los Angeles by sending a request to

The Hospital to Home Transitions project was a partnership between Alzheimer’s Los Angeles, UCLA Department of Neurology, and Partners in Care Foundation.
Financial assistance for this project was supported by a grant from UniHealth Foundation, a non-profit philanthropic organization whose mission is to support and facilitate activities that significantly improve the health and well-being of individuals and communities within its service area.