We work closely with our patients and their families to manage the transition back to home or to a rehabilitation facility after hospitalization. Our providers offer a range of services to help meet the needs of older adults during a stay at a skilled nursing, hospice or rehabilitation facility, including:
Medication review and management
Management and treatment of multiple chronic illnesses
Physical function assessments
Cognitive and memory care
Assistance with transition from the hospital to a rehabilitation, hospice or skilled nursing facility
Assistance with transition from a rehabilitation or skilled nursing facility to home
Referrals for specialized services, such as home care and physical or occupational therapy
Coordination of care with facility staff and other physicians
Our Transition Team
We have an experienced team of providers dedicated to providing geriatric care at skilled nursing, hospice and rehabilitation facilities.
For more information about Geriatrics services or to schedule an appointment:
Home health care is often appropriate for elderly patients with congestive heart failure (CHF), COPD, diabetes, orthopedic recovery, stroke, chronic kidney disease, wound care, dementia and behavioral health needs.