Individuals transitioning from acute care back to their homes often are unaware of community support services that could ensure the success of this move, and hospital discharge planners have difficulty extending their support beyond the hospital's door. To address these problems, Marin County Division of Aging established Project Independence with funding from the California Long-Term Care Innovation Grant program. Project Independence uses Volunteer Advocates to provide short-term assistance to patients leaving the hospital. Such help may include understanding and following through with discharge plans and medication orders, and coordinating community services such as home-delivered meals, transportation, and home health care.

BPA served as evaluator for Project Independence. The evaluation examined several outcomes of the project, including:
- cost-effectiveness;
- decrease in the number of readmissions to acute care;
- decrease in the number of admissions to skilled nursing facilities (or for those admitted to SNFs on a temporary basis, decrease in length of stay in SNF);
- increase in the number of individuals living independently with family or other informal supports; and
- improved quality of life for participants.

In addition to conducting telephone surveys with Project Independence stakeholders (i.e., participants, volunteers, and discharge planners), the evaluation collected aggregate comparison data on hospital readmissions for individuals who qualify for the program but do not receive services. BPA staff are also using data from the National Health Interview Survey (NHIS) and other public access databases to establish the comparative impact of Project Independence.

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