Transitional Care

When you are leaving the hospital to go home, we:

• can pair you with a Case Manager to help manage your needs in the first thirty (30) days discharge from the hospital.
• will work with the discharge planner at the hospital to make sure that all your referrals are going to the appropriate home health agencies.
  
• monitor you and your needs until you improve. If you need a little more help after your transition period home, we'll talk about the option of palliative care.