Are you currently residing in a skilled nursing facility (SNF) and want to return home?

Transitioning out of a skilled nursing facility can seem like one challenge after another. That’s why the Community Transitions Liaison Program (CTLP) is here to help you.

Through the CTLP, a Community Transition Liaison (CTL) will remain on-site in your skilled nursing facility and will assist you in transitioning back to the community.

  • Act as an onsite point of contact for residents, families, and SNF staff in facilitating the transition back to the community
  • Work with SNF staff on discharge planning
  • Participate in resident and family discussions to inform you of options and help with developing a transition plan
  • Identify barriers to returning home and how to overcome them
  • Facilitate referrals and follow-ups to state programs and community resources to provide support at home
  • Gathers and facilitates completing required documentation for housing searches, SNAP, MassHealth and other programs as necessary.

Safely transitioning out of a skilled nursing facility to home requires careful planning and up-to-date knowledge of community resources and state programs. The CTLP helps you make informed choices about long-term services and supports (LTSS) so you can make a seamless transition back home.


The CTLP is available to all nursing facility residents over 22 years of age, regardless of insurance type, who are interested in returning to live in the community. If you are unsure if you meet the qualifications, our CTLs are happy to chat with you to assess your eligibility. For more information, contact of our Information and Referral specialists at Boston ElderINFO at 617-292-6211 or click below.