What is Transitional Care?
Angelic Health’s Transitional Care team provides patients with a smooth transition from hospital or rehabilitation facility to home. Our trained staff, which include an Advance Practice Nurse (APN), Registered Nurse (RN), and social worker, work with the facility and your community providers to ensure that your move back home is seamless.
Too often patients with chronic or serious conditions move from one healthcare setting to the next and experience frequent changes to their care plan, medication regimen, or treatments and miss out on sufficient communication to manage their own care at home. Angelic Transitional Care coordinates the continuity of care during the transfer from healthcare setting to home to avoid mishaps with medications and treatments, ensuring patients are home safely and understand how to care for themselves effectively. These services are time-limited and are focused on ensuring continuity of care, safety, and avoiding preventable re-hospitalizations.
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Angelic Health Transitional Care
Anyone transitioning to home from a stay in the hospital or rehabilitation facility qualifies for Transitional Care. Patients with lengthy stays away from home or chronic conditions benefit the most from this program.
How is transitional care paid?
Transitional Care is covered by Medicare, Medicaid, and most insurance plans. Co-pays may apply.
What we provide
Prior to discharge we speak with your care team and may meet with you in the facility to discuss your transition home. After discharge a RN or social worker will contact you by phone and, within a few days, the APN will visit you at your home. If additional visits are needed, we will work with you and your physician to ensure that your needs are met. If additional care is needed to manage a symptom related to a serious or chronic condition, you may be eligible for Angelic's Palliative Care program which will work with you and your physician to resolve those issues over a longer period of time.
To learn if you or a loved one could benefit from transitional care services call 609.822.7979 or email us at email@example.com for a consultation.