You may have seen various books or online media discussing the importance of Transition Care when a senior is discharged from a hospital. Before Transition Care became popular, common breakdowns in care were prevalent when older adults with complex needs transitioned from the acute care setting to their home. What has changed with Transition Care is that patients and family caregivers or care management nurses now more effectively manage changes in health with Seniors who have multiple chronic illnesses. To be sure this has made a positive impact on older adult outcomes and has even reduced some of the costs of healthcare. How?
Transition Care has resulted in fewer hospital re-admissions for patients, reducing the number of days spent in the hospital which is now shorter than expected. Another way that Transition Care has helped is with the improvements in physical health, functional status and quality of life. Transition Care has even improved overall patient satisfaction.
With our own elder care management clients we've even noticed the ability to lessen the burden among family members by reducing the demands of care giving. Because of tailored care to individuals, we've been better able to coordinate care, collaborate with older adults, caregivers, and team members in prioritizing needs, goals, and preferences set by the medical staff. We are better able to care plan with an eye at promoting positive health staying in contact with our client's physicians.
A multidisciplinary approach that includes the health care provider, patient, caregivers and care managers as members of the team has indeed improved the care of persons with chronic conditions.
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If you are an out of town family member with a parent living with a chronic disease please give us a call. We can certainly ease the stress of having to fly to Florida every time mom or dad needs another hospital admission. Transition Care for Seniors is certainly our passion and something we are experienced in. Call us to set up an appointment the next time you are in town. We can be reached at 561-235-2490. If we happen to be out, feel free to leave a message. Someone from our staff will return your call. You might also want to try my cell
Posted Aug, 2, 2016.....Olga Brunner, M.Sc, Gerontology, CECM
Tags: Transition Care; Elder Care Management; Hospital Re-Admissions
Please feel free to comment, Thanks.
I Have worn many hats in my day: Nursing Home Assistant Admin and Activities Director, Assisted Living Admin, Case Management for the State-wide Medicaid Program, and Trainer for Dept of Elder Affairs.