Returning Home

by Lois Etienne on February 27, 2013

in Caregiver Support,Senior Health and Safety

On October 1, 2012, Medicare’s Hospital Readmissions Reduction Program went into effect, intended to give hospitals financial incentive to ensure patients receive proper discharge instructions and post-discharge support.

The intensely debated Medicare penalties for excessive readmissions have put doctors, discharge nurses and other healthcare professionals across the hospital industry in a position that has them looking at all options to ensure that seniors are not back in the hospital within those first thirty days.

insights-dec-2012-transitional-care-servicesThe Home Instead Senior Care® network’s Returning HomeSM transitional care services program covers and assists with all of the things that Medicare has identified as reasons for readmission. Returning Home transitional care services include:
• Discharge plan of care – making sure that the discharge instructions are understood and agreeable
• Medication management – assistance organizing and tracking medications to make sure they’re taken as directed.
• Follow-up physician visit assistance – helping seniors keep track of and attend all necessary follow up appointments
• Nutrition management –providing assistance with food shopping and meal preparation to help ensure the senior maintains a healthy diet.
• Warning sign monitoring and notification – watching for warning signs and taking appropriate action.
• Record keeping – keeping track of the senior’s recovery progress to share with his or her physicians.

I’ll be sharing more specific information on these six areas next time but if you need more information about readmission reduction and transitional care services sooner, visit

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