Transitional care is intended to provide the right level of care for patients to support their move back to the community or to another level of care (e.g. high intensity rehabilitation). This model supports individuals who no longer need acute care but are not yet ready to go home, and helps patients avoid an Emergency Department visit or admission.
Aimed at reducing the challenge of hallway medicine in acute care hospitals, Providence Care is embracing this new level of care to help frail older adults avoid being designated as needing an alternate level of care (ALC) for long-term care. It is designed to not only support flow with acute and sub-acute hospitals, but also to help these patients avoid an Emergency Department visit or admission.
Using the ‘assess and restore’ principles of convalescence, respite and restorative care, services in Providence Transitional Care Centre are designed to provide frail adults with an integrated approach to care, including a high level of activation throughout the day, more timely access to assessment, earlier identification of need, care navigation, respite and engagement with services and a variety of health care partners to optimize community reintegration.
The following services will be provided at PTCC:
- Restorative care for patients to build strength and stamina, enabling them to better manage at home or prepare for higher intensity rehabilitation
- Transitional care for patients after an acute or rehabilitative stay while they prepare for discharge
- Cognitive behavioural support to help patients manage mild to moderate behavioural and/or cognitive impairment or wandering
- Short-stay respite for caregivers and frail, older adults who are experiencing fatigue/burnout providing care for their loved one
- Convalescent care to help patients maintain strength while awaiting another medical procedure or transition to rehabilitation
Length of stay
Inpatients will have a length of stay of up to 60 to 90 days and have a known discharge location (typically home).
Our goal is to ensure patients are receiving “the right care in the right place,” according to their individual care needs. Once a patient no longer requires the level of care provided at Providence Transitional Care Centre, it is in his or her best interest to return home or to a more appropriate care setting. Planning for discharge starts as soon as a patient arrives, so that required care and services are in place after the hospital stay.