The Transitions Home program extends health care services from the hospital into your home, which allows for continuity of care, enhanced patient and caregiver experience and improved health care experiences.
Your care team, made up of a variety of health care professionals, will support you during your transition from the hospital to home and provide the necessary in-home therapy services for a safe transition. The goal of the program is to make your transition home from hospital as successful and positive as possible and allow you to remain living in the community with an enhanced quality of life, through improved access and continuity of care.
Benefits of the Program
- Improved continuity of care from hospital to home
- Increased access to necessary care once discharged
- Reduced wait time for in-home care services
- Improved communication between health care providers
- Decreased length of stay in the hospital setting
- Decreased chance of returning to hospital
Who is eligible for the program?
You are eligible if you are scheduled for discharge to your home or community location from Providence Care Hospital or Providence Transitional Care Centre and require additional support to make the transition from hospital to home as smooth and successful as possible.
How does the Transitions Home program work?
Before leaving the hospital, your care team from the Transitions Home program and the hospital will work with you to ensure a smooth transition of your care. Your first home visit(s) will be scheduled before you leave the hospital, and you will know the name(s) and possibly faces of the staff that will be coming to your home.
Health care professionals including a clinical coordinator, physiotherapists, occupational therapists, recreation therapists and social workers will provide care for you in your home.
The number of sessions and duration of these services will be determined collaboratively between you and the therapists as part of your individual care plan.
Transitions Home includes but is not limited to:
- Pre-discharge home safety assessment
- Recommended safety/mobility equipment provided for up to 30 days
- Development of an individualized exercise program in your home/the community
- Referral and connection to community supports and services
- Support with re-integration to home and community life
How long does the Transitions Home program last?
The Transitions Home program’s duration will be determined jointly between you and your care team.
Appointments are held in your home or within the community. Virtual visits may be utilized, as appropriate. To arrange, reschedule or cancel appointments, contact: 613-544-4900 ext. 53230.
Only current inpatients are eligible for this program.
For more information about the Transitions Home program or to manage appointments, contact: 613-544-4900 ext. 53230.