Transition from Nursing to Community Care with the Nursing Home Transition (NHT) Program

Helping older Pennsylvanians transition to independent living.


The NHT Program was developed to assist and empower consumers who want to move from a nursing facility back to a home of their choice in the community.

When given a choice, an overwhelming number of people say they want to age in place in their homes rather than in institutions. Yet, in publicly funded programs, the bias has always been toward institutional care. NHT provides the opportunity for individuals and their families or caregivers to be fully informed of all long-term services and supports options, including the full range of available home and community-based services (HCBS).

Through the NHT program, individuals can receive the guidance and support they need to make informed choices about their long-term services and supports. The program assists individuals in moving out of institutions and eliminates barriers in service systems so that individuals receive services and supports in settings of their choice.

Preserving Existing Housing

If you still have appropriate housing to return to and expect to be able to be discharged from the nursing facility within 180 days, you may be eligible to set aside some of your income to use towards upkeep of your housing through the Home Maintenance Deduction. Eligibility for the Home Maintenance Deduction is determined by the County Assistance Office. The nursing facility social worker can assist you in the application process.

Modifying Existing Housing

Sometimes existing housing is no longer safe or accessible. If you have a home but cannot return to it as-is due to a change in your condition, you may be able to get help with modifying or adapting your home to make it accessible. Many of the Home and Community-Based Waivers include funding for home modifications.

Below are some links to additional information and resources related to home modifications, accessibility adaptations, and assistive technology:

Locating New Housing

If you do not already have appropriate housing but you wish to return to the community, one of the first steps to transition is to locate affordable, accessible housing. is a searchable database that can assist you in finding appropriate housing.

You may also find useful information at the Pennsylvania Housing and Finance Agency (PHFA) website.

Goals and Objectives of the NHT Program

  • Help rebalance the long-term living system in Pennsylvania so you have a choice of where you live and receive services.
  • Enhance opportunities for individuals to move to the community by identifying individuals who wish to return to the community.
  • Identify and overcome barriers that prevent transitions.
  • Empower you so you are involved in planning and directing your own transition from a nursing facility back to a home of your choosing in the community.
  • Develop the necessary infrastructure and supports in the community.
  • Expand and strengthen collaboration between aging and disability organizations to provide support and expertise to the NHT Program.
  • Educate you and your families about long-term living services.

Apply for a Home and Community Based Services Medicaid Waiver

To see if you are eligible to receive long-term care services and supports in a home in the community instead of in a nursing facility, contact the Pennsylvania Independent Enrollment Broker (IEB). 


To be eligible for this program, you or your family member must work with a Nursing Home Transition coordinator. They will determine eligibility based your specific health circumstances and housing situation.

Learn how to start your transition out of a nursing facility.

If you or a loved one are interested in returning to the community from the nursing facility, you may initiate the nursing home transition process by:

  • Contacting nursing facility staff to initiate a NHT referral OR
  • Directly contacting an NHT Coordination provider:
    • If you are enrolled in Community HealthChoices (CHC), please contact contact your CHC-Managed Care Organization (MCO) to request NHT assistance.
    • If you are enrolled in the Living Independence for the Elderly (LIFE) program, please contact your LIFE provider.
    • If you are not enrolled in CHC, please contact Acentra Health (formerly Kepro) through their website or by calling 1-888-204-8781.

Documents you'll need when you apply:

In order to complete applications for housing and/or benefits, you may need to provide documents verifying certain important information. Below is a list of commonly required documentation.

  • Proof of earned and unearned income
  • Proof of resources (e.g. bank accounts, stocks, etc.)
  • Proof of identity:
    • Birth Certificate
    • Social Security Number/Card
    • Driver's License/PA ID Card
    • Credit Report
    • Military Records
    • Criminal History

Helpful Transition Tools

There are many things you can do to prepare for the transition. The following are checklists developed by Nursing Home Transition providers, partners, or agencies which may be helpful for individuals in planning their transitions.

Frequently Asked Questions

You may request NHT assistance by contacting a nursing facility social worker, by contacting your Community HealthChoices Managed Care Organization or LIFE provider if you are enrolled in managed long-term care, or by calling Acentra Health if you are not enrolled in managed long-term care (see Application Process section above for more information.). If you are still not sure who you should contact, you can call the Office of Long-Term Living NHT Helpline at 1-800-833-5196

The length of time it takes to plan and complete a safe transition back to the community can vary greatly. This is because it depends on many things, such as how difficult it is to find appropriate housing, how long home modifications or adaptations may take, how long it takes to apply for and arrange services in the home, and other unpredictable or variable factors. An NHT coordinator can help to plan these steps so that they can be completed as efficiently as possible.  

While there are risks involved in living independently in the community, just as there are risks in living in a nursing facility or anywhere else, it is possible, through thoughtful and thorough evaluation and planning, to identify and address risks that community living may pose. Every situation is different, so care planning should be person-centered to take into account specific barriers an individual may have as well as their level of willingness to accept risks that may still exist. With the help of their transition planning team, individuals can put in place services, supports, and adaptations to mitigate risks to the extent that they can feel comfortable with their transition and new living arrangement. In the event that risks cannot be adequately mitigated, transition planning may be discontinued, either temporarily or permanently. 

Contact OLTL

Call the Helpline

If you have any difficulty or need assistance in this process, you may contact the Office of Long-Term Living Nursing Home Transition Helpline at 1 (800) 833-5196.

Helpline: 1 (800) 833-5196