Islands Transitional Care
What is Transitional Care?The Islands Transitional Care Program is a no-cost, 30-day, community-based resource program focused on goal setting, informed decision-making and setting patients up for success. Our experienced nurses and medical social workers have a proven track record of preventing and decreasing hospitalizations and setting up resources for those in need.
What can transitional care help you with?
- Reduce frequent hospitalizations
- Address chronic conditions
- Assist with financial applications
- Address lack of resources or support
- Assist with obtaining and taking medications
- Provide education regarding disease progression
- Assist with advanced care planning
How does it work?
Our transitional care team prevents hospital re-admissions by:
- Providing medication reconciliation upon discharge from one level of care to the next
- Setting up resources
- Assisting with applications for needed resources such as transportation, food resources and medical assistance.
- Working with other community providers to improve communication and continuum of care
Contact Islands Hospice to see if transitional care is right for you.