Improve Senior Health Outcomes Post-Hospitalization with Transitional Care

Senior Health Outcomes, nurse taking a patient's blood pressure

There’s presently a leading priority for hospitals: decreasing readmissions for patients who are at high risk. Healthcare Financial Management Association’s article “Two Ways Hospitals Can Reduce Avoidable Readmissions” outlines that successful initiatives from several hospitals with lower 30-day rehospitalizations are, to some extent, the result of collaborating with inpatient and outpatient care providers, such as Stay Home Care, who can provide a continuum of care and improve senior health outcomes.

The hospitals mentioned in the article provided the recommendations below to help decrease rehospitalizations and improve senior health outcomes:

  • Start planning and preparing for a patient’s discharge from a hospital visit on the day he or she is admitted. When an older person is admitted to the hospital, call a home care agency, like Stay Home Care, to make arrangements for in-home care upon being discharged. Patient outcomes are improved when home care services are in place as soon as possible following discharge.
  • Identify patients who might be at a greater risk for concerns after discharge for further care coordination and/or case management services. (Make sure social workers visit all patients age 80 and over to help with care needs.)
  • Use technology to assess, track, or refer patients. 
  • Conduct an in-depth analysis of the patient’s care needs, risk factors, available resources, understanding and management of the disease or health condition, and amount of family support.

At Stay Home Care, trusted provider of home care in Mt. Juliet, TN and surrounding areas, we realize how essential it is to establish a transitional care plan to lessen the risk of hospital readmissions for seniors. We help clients plan for care needs starting on day one of their hospital stay, monitoring their health and making certain that care plans are put in place as soon as they return home. Contact us at 615-964-7726 or reach us through our online contact form to find out more about how we can help someone you love transition from hospital to home with professional home care services such as:

  • Supplying training and help with chronic disease management
  • Medication reminders so meds are taken exactly as prescribed
  • Help with coordination and balance
  • And much more

Avoid an unnecessary follow-up hospital visit. Partner with Stay Home Care for assistance.