Differentiators
What happens when you’re discharged from the hospital, but still have a long road to recovery ahead of you?
Maybe you had surgery and are still relying on complicated medical equipment, or you’re recovering from an illness and are too weak to care for yourself. How are you supposed to manage the gap between hospitalization and getting back to normal?
That’s where transitional care comes in. It’s there to support you as you move from the hospital to home and lower your chances of being readmitted.
Read on to learn about seven reasons that transitional care might be your best option for recovery.
1. Chronic Medical Conditions
People with chronic medical conditions are more likely to experience preventable hospitalizations and poor outcomes from their medical care. They often see a large number of physicians in different specialties, making it hard to keep all of them in the know.
Because poor transitions from hospitals to home result in higher readmission rates, it’s important to make sure yours is seamless—especially if you have underlying chronic conditions. A transitional care team can monitor your health during your first month home and send reports back to your doctors. This way, all your care providers can stay on the same page and give you the high-quality care you deserve.
2. Complex Therapy or Medication Plan
Even if you don’t have any underlying chronic conditions, taking care of yourself after a serious illness or injury can be complicated. There may be therapy regimens to follow, medications that have to be taken a specific way, and medical devices you don’t feel comfortable using by yourself.
If you have a complex discharge plan, a transitional care team can work with you at home to make sure you feel comfortable taking care of yourself
3. Behavioral and Psychosocial Concerns
Physical conditions aren’t the only reason transitional care could be beneficial. Behavioral and psychosocial concerns can also be a reason to consider it.
Conditions like dementia, mental illness, and brain trauma can make sticking to a medication or wound care schedule difficult. But a transitional care nurse can be there to help administer meds on time, change bandage dressings, and make sure you don’t miss any follow-up appointments. They can also provide resources and support for people struggling with addictions that could negatively impact their recovery.
4. Old Age
As we age, our likelihood of being readmitted to the hospital after discharge increases. There are quite a few theories as to why this is the case. Memory problems, inability to get to follow-up appointments and chronic age-related conditions could all contribute.
But no matter the cause, there’s one thing that’s certain: transitional care decreases your chances of hospital re-admission regardless of your age. In fact, patients of Global Transitional Care have only a 5% all-cause readmission rate compared to the national average of 18-19%.
5. Ready to Go Home, but Not to Be Alone
Transitional health care fills the gap for people who don’t need the full-time care of a nursing home or rehab facility but aren’t quite ready to live on their own again.
When you arrive home after being discharged, your transitional care nurse will check in with you. They’ll decide how often you will need a care professional to visit your home during the upcoming month. There isn’t a minimum number of home visits you have to have or an upper limit—it’s determined by your individual situation.
For the remainder of the 30 days, you’ll get healthcare support at home from a team of nurses and nurse practitioners under the direction of a doctor. If you have questions or concerns, you can contact your care team at any time. They’ll keep your other doctors in the loop so everyone stays on the same page throughout your recovery.
6. Support Family Caregivers
Family caregivers are the unsung heroes of the medical world. They’re often medically untrained and busy with careers and household duties. Even so, they give of their time and energy to care for parents and other family members in their times of need.
Even the best family caregivers need support, though. If you still need a lot of medical care after being discharged, your family might not be able to do it on their own.
Thankfully, a transitional care team is there to help. Not only will they provide home visits for the first month, but they’ll also educate you and your family members on long-term healthcare strategies. You won’t be in the dark through your recovery—you’ll have a dedicated team of people to answer your questions along the way.
7. Medicare Coverage
If you have health insurance through Medicare, they may cover some or all of your transitional care costs. Medicare allows transitional care coverage for up to 30 days after you’ve been discharged from the hospital or another care facility. On occasion, you may be able to apply for an extension beyond the normal 30 days of care.
If you don’t have Medicare, that doesn’t automatically disqualify you from transitional care. Check with your insurance provider to see what they will cover, or talk to your care providers at the hospital to see if you can set up a flexible payment plan.
At CarePartners, we’ll work with you even if you aren’t Medicare eligible. We can set up an affordable private payment plan so you can get the care you need, regardless of your insurance coverage.
Is Transitional Care the Right Choice for You?
When you’re being discharged from the hospital, rehab center, or another long-term care facility, make sure that you have a complete plan for your care at home. Transitional care may be the best option if your condition is medically complex or if you’re at risk of readmission.
If you’re looking for expert transitional care services in the Orange County and San Bernadino area, CarePartners can help. Contact us today to get started.
