Transition of Care

From the time you enter the hospital as a patient, a Discharge Team will be working with you to help ensure a smooth transition to home or another level of care. This Discharge Transition Team consists of Physicians, Nurses, Social Workers, Discharge Planners and Case Managers who have expertise in arranging for additional support or equipment in the home after discharge, as needed. This team can also assist you and your family in selecting an appropriate alternative living arrangement such as a Skilled Nursing Facility, Assisted Living Facility, etc.

Our Discharge Team will help ensure that your and your family’s preferences are taken into account when making decisions about your healthcare needs. They will work closely with you and your insurance company to provide options, as appropriate. Our team will also work with you throughout your hospitalization to assist you in understanding how to manage your healthcare needs, provide you with educational materials about your medical condition, and assist you in medication management at home.