Hospital to home care

The first two weeks after a discharge decide whether someone stays home or comes straight back through the emergency department. Most readmissions trace back to something ordinary — a medication missed, a fall on day three, nobody at home to notice things going wrong.

We take same-day referrals. Discharge planners can send a referral and call at the same time, and we will start staffing while we are still reading it.

What is included

• Same-day and next-day starts
• Someone in the home from the moment they arrive
• Medication reminders on the new schedule
• Watching for changes and calling early
• Help to the bathroom and around the house
• Meals and hydration
• Transport to follow-up appointments
• Coordination with home health and therapy

We are used to taking referrals from

• Hospital discharge planners and case managers
• Skilled nursing and rehab facilities
• Home health and hospice liaisons
• Physicians and nurse practitioners
• Families arranging care at short notice

If you are a discharge planner reading this on a Friday afternoon, send the referral and call. That combination gets it moving fastest.