How transitional care services help patients reclaim their independence

Transitional care, commonly referred to as swing bed by Medicare, encourages the smooth and effective transition of patients from one healthcare setting to another, such as from a hospital to a home or a rehabilitation facility. Think of it as a “pit stop” on the way to a patient’s identified destination that helps improve patient outcomes, enhance continuity of care, and reduce the risks of complications and readmissions. Typically, patients in a transitional care program are enrolled following a hospitalization, surgery, or significant medical event – in which case they may not require full hospital admission, but would likely benefit from some additional support before returning home. Having access to necessary support and care during such a crucial time is the purpose behind transitional care.

 Each transitional care stay is unique as the care is dependent upon a patient’s individual care needs, although all patients admitted must meet the basic program admission requirements. Services offered in a transitional care program may vary depending on the system but here at BRMH our transitional care program consists of the following services: skilled nursing, nutrition, therapy (speech, respiratory, occupational, and physical), pharmacy, and social work. Providing these services to our patients through a comprehensive team made up of medical professionals, helps ensure our patients are successful upon completion – showcased by our 88% return to independence rate.

Patients are cared for by nursing, rehabilitation, and social work staff and can expect provider visits weekly. BRMH also offers 24/7 access to a team of hospitalists, to accommodate patients who have a more active diagnosis.

Even with transitional care patients being in a hospital environment, the program allows them to start adapting back to normal life. Patients are encouraged to wear their own clothing and shoes and bring any personal items that help them feel more like themselves. Family and friends are invited to visit and even take patients on small outings if they so wish. Patients can take advantage of private, in-room dining or venture down to our café for a more social experience – some even comparing the stay to a 5-star hotel!

Patients, in collaboration with their families, reserve the right to decide what program is the best fit for them.

If you are interested in learning more about what a transitional care stay may entail, please click HERE.