Resources for
Discharge Teams
Curated national resources for SDOH referrals, caregiver support, benefits navigation, and CMS data — all free, works in any state.
SDOH & Community Resources
Free national resources — no zip code required, no API, no account.
Food & Nutrition
Housing & Transportation
211.org
The national SDOH backbone — food, housing, utilities, and more by zip code. Free, always works, no account required.
HUD Housing Counseling
Free housing counselors for rental assistance, foreclosure prevention, and transitional housing
NADTC Transportation Resources
National Aging and Disability Transportation Center — NEMT resources and local transit locators
Financial Assistance
BenefitsCheckUp — NCOA
Comprehensive screening for 2,000+ federal, state, and local benefit programs
Social Security Administration
SSI, SSDI, retirement benefits, and appeals information
Medicare Extra Help (Low-Income Subsidy)
Federal assistance with Medicare Part D prescription costs for eligible beneficiaries
Mental Health & Behavioral
SAMHSA National Helpline
Free, confidential treatment referrals — mental health and substance use disorders, 24/7
Crisis Text Line
Text HOME to 741741 — free crisis counseling via text, 24/7, any topic
NAMI — National Alliance on Mental Illness
Education, advocacy, and local support groups for patients and families
Caregiver Support
ARCH National Respite Network
Locate respite care programs that give family caregivers temporary relief
Caregiver Action Network
Peer support, education, and advocacy for the 90 million family caregivers in the US
Eldercare Locator
Official ACL resource — find local aging services by zip code in any state
Medicaid & Benefits
Family Guides & Patient Education
Clear, empathetic guides designed to be shared directly with patients and family members to help them navigate the transition to subacute care.
Questions Every Family Has
The most common questions — and honest answers to each one.
What to Bring: and What to Leave Home
A simple, practical packing checklist for the facility stay.
When Medicare Stops: What Comes Next?
Day 21, day 100, Medicaid spend-down — explained clearly.
Home Care or a Rehab Facility?
What each option involves, who qualifies, and what insurance covers.
For Social Workers
Support your families with clear information. These resources are designed to reduce discharge anxiety and build trust in the placement process.
Browse all 51 family guidesReference Tools
Primary sources and data tools
Put it into practice
Search by clinical need, payer, and location — or check the Transparency Hub before placing a patient with an unfamiliar operator.