Transitional Care in Portland West

Family Resource Home Care provides quality Transitional Care Services in Portland West by assisting with the medical facility’s discharge plan

When a family member is preparing to return home after a stay in a nursing home, rehabilitation center, or hospital, the discharge planning process is vital. This process involves collaboration between medical and administrative staff, the patient, and their family to discuss the necessary steps for a smooth transition and the best possible recovery outcomes.

At Family Resource Home Care, we offer this service as Transitional (or Post-Hospitalization) Care in Portland West. It’s customizable for anyone needing temporary assistance, not just seniors.

Learn more about how to set up quality Transitional Care services in Portland West for yourself or a loved one, and find out how Family Resource can help ensure a seamless transition with no lapses in care or service.

What is Transitional Care?

Transitional Care involves a range of time-sensitive services designed to ensure continuity of care and support the safe transfer of patients between different care settings. Research shows that these transitions are particularly vulnerable times for patients, and effective Transitional Care can significantly lower the risk of hospital readmissions. A recent study of Medicare beneficiaries found that 19.6% of older adults were readmitted within 30 days of discharge, with 34% rehospitalized within 90 days. Patients discharged with medical conditions faced a 67% readmission rate, while 51.5% of those who had surgery were rehospitalized.

Family Resource Home Care’s Transitional Care Service in Portland West ensures that discharge instructions from medical facilities are carefully followed to promote the best possible outcomes and minimize the risk of complications or rehospitalization. We integrate the facility’s discharge plan into a personalized home care plan created in collaboration with you and your loved one. Our services are designed to complement, not replace, any skilled nursing services covered by Medicare or health insurance.

Family Resource Home Care’s Transitional Care in Portland West includes a range of services that align with the facility’s discharge plan, along with any additional services necessary, such as:

• Transportation from hospital, skilled nursing, or other care facility to home
• Meal planning and preparation, following dietary instructions or restrictions
• Medication assistance
• Assistance with movement, toileting, bathing, and dressing
• Transportation to follow up appointments
• Assistance with ongoing therapy (physical, speech, occupational)

The period after hospitalization is vital for recovery, as it requires patients to limit their activities and focus on rest. One of the key roles of Family Resource caregivers is to support discharged patients by ensuring the discharge plan is followed and preventing overexertion. Additionally, post-surgery discomfort or illness can add to a patient’s stress. A compassionate, skilled caregiver can significantly reduce this stress, offering much-needed comfort and providing valuable respite for family caregivers in Portland West.

Let us help ensure your loved one’s transition to home is seamless

Depending on your situation, you may have weeks or even months to prepare for your own or a loved one’s discharge from a hospital, rehabilitation center, or care facility. Alternatively, you might only have a day or two. No matter when you begin considering your needs or whether home care is the right choice, we encourage you to reach out. The experts at Family Resource Home Care are here to assist with discharge planning and create a personalized home care plan to support your smooth transition home.

At Family Resource Home Care, we offer flexible, customizable services that can be tailored to meet the unique needs and preferences of each client. You’re never locked into a set level of service or frequency. Our experienced and highly qualified caregivers ensure a seamless transition home, providing you and your loved one with peace of mind in Portland West.

Discharge planning informs Home Care planning

At Family Resource Home Care, we prioritize understanding and listening to our clients.

When the time comes, we will thoroughly review the discharge documents and work closely with you and your loved one to develop a personalized, comprehensive care plan that meets their specific needs. This plan will take into account medical conditions, physical limitations, cognitive concerns, medications, physician instructions, and personal preferences. Some tasks will be based on the discharge instructions, while others will be shaped by the home care assessment we conduct.