My Transitional Care Plan© (MTCP) summarizes meaningful information that contributes to the facilitation of successful transitions across sectors for older adults presenting with, or at risk of, responsive behaviours/ personal expressions associated with dementia, complex mental health, substance use and/or other neurological conditions. MTCP presents a synopsis of essential information for sharing between members of a person’s care team from both their existing and new location.  MTCP is intended for temporary use, to prepare and facilitate a move, following which information may be extracted from it to populate a formal care plan. All members of Behavioural Supports Ontario teams as well as other healthcare providers and partners who have assessment and/or care planning in their scope of practice can use MTCP.

Mon plan de soins de transition© et ses ressources de soutient sont aussi disponibles en français. (My Transitional Care Plan© and its supporting resources are also available in French.)
 

Resources

My Transitional Care Plan

My Transitional Care Plan©: Tool Download & Permissions

My Transitional Care Plan© is available for download following a review of permissions to preserve its integrity.

Guidelines for Use

My Transitional Care Plan©: Guidelines for Use

These guidelines provide an overview of the purpose of the tool as well as instructions for use.

Fictitious examples of completed My Transitional Care Plans© for education and training purposes.

My Transitional Care Plan©: Completed Examples

Fictitious examples of completed My Transitional Care Plans© for education and training purposes.

Mon plan de soins de transition© et ses ressources de soutien sont disponibles en Français.

Mon plan de soins de transition© en Français

Mon plan de soins de transition© et ses ressources de soutien sont disponibles en Français.

MTCP-C19

My Transitional Care Plan during the Covid-19 Pandemic

Version created specifically to support moves taking place during the Covid-19 Pandemic. It includes special fields pertaining to IPAC measures, isolation care plans, and other factors to consider

Other Resources

Other Resources related to Supporting Transitions

Learn more about the Behavioural Supports Integrated Teams (BSIT) Collaborative and review other resources that they have created related to supporting transitions.