Transitional Care

Transitional Care –
Elder Care in Sunrise, Fort Lauderdale, Hollywood, Cooper City, Plantation nad Pembroke Pines

  • Transitional Care is aimed at promoting coordination and collaboration across care settings to ensure proper patient outcome.
  • Transitional Care improves patient outcome and compliance through teaching and monitoring.
  • Transitional Care bridges the gap between acute episodes and reduces re-hospitalization.
  • Transitional Care provides smooth transition from hospital care to self-management at home.

Recent Study Results:

  • When older patients get discharged from a hospital, 1 out of 5 of them will go right back within a month.
  • Every time an older adult is hospitalized, it generally results in changes in their plan of care.
  • Instructions can be hard to follow, like new prescriptions.
  • The patient goes home with a new set of prescriptions but already have drugs in their cabinet and wonder, ‘should I be taking these plus these?’
  • Its win-win-win when you implement transitional care: the patient is better off, Medicare is better off and outcomes are better off.
  • CHF is the one of the leading causes of hospitalization and recurrent readmissions.
  • Diabetes is often called a “silent disease” and preventing short-term and long-term complications is enhanced by practicing healthy self-care behaviors.

Homecare benefits:

  • Home health clinicians have clear advantages in assessing and promoting self-management due to comfortable patient setting, ability to directly observe specific activities, and opportunity to understand non-adherence.
  • Non-compliance with treatment plans can be better understood and potentially remedied through working together in a familiar environment.
  • Providing care in the patient’s home affords a greater advantage not found in other healthcare settings
  • One-on-one scenarios afford a better understanding of the barriers patients and their caregivers face.
  • Homecare can decrease the overall spending of healthcare dollars for chronic care while still maintaining quality.
  • Homecare outcomes can be shared across healthcare settings and used to manage patients collaboratively.

DON’T HESITATE….. MAKE THE REFERRAL…. IMPROVE THE OUTCOMES