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A free, evidence-based program that helps individuals during their hospital discharge to navigate medical and social service systems and establish necessary supports of care. Additional assistance such as Medication Management and referrals to community-based resources are provided.

The Welcome Home program is a limited, four-week program for people being discharged from the hospital. Clients receive fourteen medically tailored meals within forty-eight hours of hospital discharge; meals are delivered for four weeks. Clients are also offered nutrition services with a Registered Dietician (RDN) during this time period. Welcome Home meals assist clients in their medical recovery, decrease hospital re-admissions, and improve health outcomes. Eligible clients can transfer into regular home delivery if they are eligible and funding exists. Meals are cooked in a commercial kitchen, frozen and delivered weekly. Meals meet the guidelines of the American Heart Association and the American Diabetes Association.  Also has special meals to provide for dietary restrictions (please see below). Meal Options: -  Healthy Standard - this is our regular meal category, but it is also appropriate for anyone with diabetes or heart disease. -  Easy Digestion - this category is designed to meet the needs of those struggling with ongoing diarrhea, GERD, or gastroparesis. -  Dialysis Care - this category meets the specialized needs of our clients on kidney dialysis. -  No Gluten/No Dairy - these meals are the best choice for those with gluten intolerance, celiac disease, or lactose intolerance. - No Pork/No Beef - if you prefer to avoid beef or pork but enjoy chicken and fish, this may be a good category for you. -  Vegetarian - these meals contain NO meat, fish, or poultry (but are not vegan).  For clients who struggle with chewing or swallowing, any of the above meal categories can be made into a soft texture (very finely chopped).

Medical Social Worker provides counseling and clinical support to individuals and families requiring emotional and physical assistance. Assesses individuals, develops program content, and selects and implements treatment programs as appropriate. Recommends community resources as necessary.

Jefferson Healthcare, in Port Townsend, Washington, is a DNV accredited, fully integrated health care system. The hospital is a 25-bed, critical access hospital under CMS guidelines, with complete 24-hour coverage by a physician staff of hospitalists. Top-rated services include 24-hour emergency department, laboratory services, acute and intensive care units, family birth center, the latest in diagnostic imaging, and a comprehensive array of respiratory, physical, speech, and occupational rehabilitation therapies.

A counseling program for patients and families dealing with cancer-related issues. A medical social worker specializing in cancer patients helps people - deal with feelings, - strengthen coping skills, - improve communications with family and friends, - make important decisions and - take control of their illness and lives. The counselor also makes referrals to appropriate community resources to help meet individual needs. Also does advance care planning with patients. All clinics have notaries available to notarize the documents.