Hospital-to-Home Transitions for Seniors
You’ve probably heard about someone who has checked out of a hospital or skilled nursing facility only to be readmitted within a few months. During the transition, medications weren’t taken, doctor appointments weren’t made and chronic illnesses weren’t cared for.
The downward spiral seems unstoppable, the medical bills were never-ending and the family was at a loss for what to do. The sad fact is that one in five people with Medicare are readmitted to the hospital within one month of discharge. Preferred Care at Home of Central New Jersey can help reduce the chances of you being one of them.
Hospital-to-home care involves the transition from a hospital or skilled nursing setting back to the home. We at Preferred Care at Home of Central New Jersey aim to provide care and support ensuring a safe and comfortable recovery at home while reducing your risk of hospital readmission.
Here is how we helped Nora during her recovery.
Nora’s Home Care Story
Nora has lived alone since her husband died ten years ago. She was facing surgery that would require a five-day hospital stay followed by several weeks in a skilled nursing facility. She did not have family nearby and wanted to return to her home.
She reached out to Preferred Care at Home of Central New Jersey for help while she was in the skilled nursing facility. Our nurse performed an assessment prior to her discharge and met with the physical and occupational therapists. After much discussion, we decided that we would provide Nora with live-in care for the first week so that she’d have assistance during the night if needed.
The Certified Home Health Aide (CHHA) would sleep in the spare bedroom so she could hear Nora if she called. We assisted her with showering and grooming, made her meals, performed housekeeping and laundry duties, drove her to follow-up appointments and provided medication reminders. We gradually reduced the number of hours each day as her condition improved.
Nora made a speedy recovery, but she realized the benefits of having a caregiver with her so she continues the services to this day.
What PCAH Can Do For You
- We’ll meet with the Discharge Planning Team to understand the services, supplies, follow-up appointments and home health services you’ll need for your rehabilitation. We’ll assist with setting up doctor’s appointments, therapist visits and pick up food and medicine.
- Our Registered Nurse will perform an Initial Health Assessment and develop a custom care plan to have in place for your first day at home. We’ll also perform a Home Safety Assessment to identify any hazards or missing assistive devices in your home. The plan may include the following services:
- Assistance with Personal Care such as bathing, grooming, and toileting
- Meal Preparation and Feeding, if needed
- Medication Pick-up and Reminders
- Light Housekeeping and Laundry
- Mobility and Therapist Recommended Exercise Support
- Scheduling of and Transportation to Doctor’s Appointments
- Our Certified Home Health Aide will implement the care plan and will report any changes to the supervising Registered Nurse and your family.
- Your care manager will visit on your first day home and will be in contact with you on your first day, first week and first month of care. She’ll also be available to you whenever you need.
We know it isn’t easy inviting strangers into your home, but we promise that we’ll become fast friends. Our caregivers are thoroughly screened through an employment interview, criminal background check, in-person employee orientation and on-the-job site visits.
Preferred Care at Home of Central New Jersey
We have had the opportunity to provide these services to many seniors returning home from a hospital or skilled nursing facility stay. This has allowed us to develop best practices for hospital-to-home care that maximizes your recovery time.
Please contact us by email or call us at 609-201-2525 to discuss your specific care needs.
