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Not ready to return home? Next steps after a hospital stay

Posted by Ridgeview Staff on Jul 31, 2018 1:00:00 PM

iStock-175229907Returning home following an extended illness, surgery, stroke or trauma isn’t always a straight path, especially if you’re an older adult who may need additional rehabilitation and skilled nursing care before it’s safe to do so. That’s when transitional care (often called a swing bed) services are needed. The goal of transitional care is to help a patient return to his or her previous living situation—whether it be a personal residence, assisted living facility or nursing home. Transitional care can reduce the risk of health complications and hospital readmission if an individual isn’t fully ready and capable to return home.

Generally, more complex patients are best cared for in a hospital setting and those requiring a lower level of services can be cared for in a nursing home.

Your provider will help you decide what’s right for you.

It’s a team approach.
Your health care needs are unique to you and so is your treatment plan. What’s great about receiving transitional care—whether it be in a hospital or nursing home—is that you have access to most of the services you need during your stay. This means less time traveling to appointments and more time to focus on your recovery.  Patients in transitional care often receive services such as:

What to expect.
In a hospital setting, providers and nursing staff are onsite 24/7 and the patient has access to lab and imaging services, rehab care, dietary consultations and more.

Will Insurance Cover Transitional Care?
In the majority of cases, the answer is “yes,” but prior to admission, a patient care coordinator will work with the transferring discharge planner/social worker to assure that insurance qualifications for admission are met, including:

  • The patient is covered by Medicare Part A or a private insurance plan covers transitional care
  • Patient had a consecutive three-day acute care hospitalization (days spent in observation do not count)
  • Patient needs daily skilled nursing or rehabilitation care at least five days a week as defined by Medicare

Rely on your provider’s recommendation.
Understandably, patients are anxious to return home following a hospital stay, but it’s not always in their best interest. Ask your provider about transitional care to help you make the best decision for a smooth transition home.   

Ridgeview offers transitional care for patients in two locations: Ridgeview Sibley Medical Center in Arlington, Minn. and Ridgeview Le Sueur Medical Center in Le Sueur, Minn. Call each location directly to learn about services offered and admissions:

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Medical and health information presented here is intended to be general in nature, and should not be viewed as a substitute for professional advice. Please consult with a health care professional for all matters relating to personal medical and health care issues. In case of an emergency, please call 911. 

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