How Cameron’s Transitional Care Unit Supports Patients After Discharge

At Cameron Hospital, the Transitional Care Unit (TCU), plays a vital role in aiding individuals from Steuben County and its surrounding communities in their recovery following a hospital stay. The TCU serves as a critical bridge, offering skilled care to enhance the likelihood of a successful transition back home after discharge.

Through intensive rehabilitation sessions, typically two to three times daily, patients in the Transitional Care program receive personalized medical care and therapy aimed at restoring their ability to perform essential tasks. This includes simulating everyday activities like getting in and out of bed, using the bathroom, showering, and meal preparation, crucial for a seamless return home.

How does the TCU work with families to prepare for a patient’s discharge?

Discharge planning commences upon admission, encompassing assessments of functional abilities, home environment evaluations, and goal setting with patients and their families. The TCU team equips families with recommended tools and equipment to enhance safety and independence, sometimes conducting in-home assessments to facilitate a smooth transition back home.

How does the TCU measure the effectiveness of its support for patients after discharge?

The TCU’s commitment to patient well-being extends beyond discharge with four follow-up calls in the first month, ensuring adherence to treatment plans, addressing medication concerns, and identifying any emerging needs promptly. This proactive approach aims to minimize readmissions and enhance patient satisfaction.

What type of medical care, therapy, and support do patients receive after their stay?

Before discharge, the TCU team schedules necessary follow-up appointments and discusses ongoing therapy needs, whether at home with assistance, through home health care, or outpatient services. Post-discharge, patients and families benefit from four follow-up calls within the initial 30 days, ensuring continuity of care, medication management, and addressing any emerging needs promptly.

How does the TCU team communicate with the patient’s physician(s) post-discharge?

Ensuring continuing comprehensive care, the TCU team arranges follow-up appointments with primary care physicians or specialists post-discharge. Collaboration with healthcare providers facilitates the setup of necessary home health care services if required, aiming to optimize patient outcomes and comfort at home.

Feedback from patients underscores high satisfaction levels, with 98.3% expressing a definitive recommendation for Cameron Hospital. The TCU’s structured follow-up protocol contributes to sustained success rates at home, underscoring its impact on long-term patient well-being.

Take a look at what previous TCU patients had to say about their time at Cameron and transition back to life at home.

“Everyone was always in a good mood and patient with my bad mood. I appreciate everyone at Cameron so much. The Dr took extra care in making sure everything was good before I went home.”

“We are so grateful for a program like this. When we found out my husband would need rehab before going home, we knew this was the only option. Everything and everyone were wonderful. The care was excellent.”

“My best hospital experience ever! The best personnel from the cafeteria staff to the head nurse, I could not have asked for better treatment.”

“All of the nurses and physical therapy went above and beyond. They were amazing!”

Cameron Hospital’s Transitional Care Unit exemplifies dedication to patient-centered care, facilitating a smooth transition from hospitalization to home through comprehensive support and personalized rehabilitation. With a focus on continuity of care and patient empowerment, the TCU stands as a cornerstone in enhancing recovery outcomes.