Transitioning Home From the Hospital

Transition to Home Care

Transition home from a hospital or Rehab stay can be wonderful and anxiety provoking at the same time. If you live alone and have been out of the house for many weeks when in hospital and Rehab center, it is a positive plan to go home with a professional. It is very compicated to go through the Discharge Plan, get the medications, come into the home which has been empty and know how to proceed with your recovery. Having a licensed nurse to help you in this transition is reassuring and can prevent problems from arising or misunderstandings about orders and meds.

Transition home from Rehab stay

What is a Transition to Homecare?

  • Licensed Nurse meets with discharge planner/social worker and receives orders on day of discharge
  • Licensed Nurse will transport client home and do a safety check
  • Orders for new RX’s are dropped off and picked up by Licensed Nurse
  • Licensed Nurse disposes of old or discontinued medications eliminating confusion
  • Education of new and existing medication by the Licensed Nurse
  • Medication set up weekly pill box by Licensed Nurse to prevent miss doses or overdose
  • Refrigerator checked for expired food

Benefits of a Transition to Homecare Program

  • Reduces or eliminates readmits to the hospital or emergency room
  • Medication compliance through education and management
  • Reinforces the recommended care plan through education of client and caregiver
  • Ensures a safe discharge home which is comforting for family members in or out of state
  • Ensures follow-up appointments are made with respective physicians
  • Helps alleviate the client’s anxiety of returning home.

 

Transition home after rehab rarely means that you are 100% fit again.  Rehab centers basically get you home ready and then you will have more Physical Therapy via Medicare once home. In all of the excitement, you may not realize how much energy and strength it will still take to continue therapy, get to doctor appointments, catch up on mail and bills and maintain the house. It is prudent to consider returning home with some type of help i.e. a Nurse for the first couple of hours and an aide for a few days, or at least until you see how you do at night.