Reducing Hospital Readmissions

Proper Discharge Planning and In-Home Care Reduces Hospital Readmissions

Hospital readmissions are a source of frustration for older adults as well as their families.  Each year, Medicare alone spends approximately $17 billion on these unplanned hospital readmissions. This common occurrence can be avoided by elevating the quality of care after a patient’s stay. This involves proper discharge planning and continuous in-home support to take the steps to reduce the chances of needing to return to the hospital.  

Professional Caregivers Help Families Navigate Discharge Instructions

Recovery at home, in a familiar place, is an effective way for an older adult to maintain their independence and avoid another hospital stay. But it is easy for families to feel overwhelmed by the intricate discharge instructions when a loved one is released from the hospital. 

The transition from hospital to home is simplified by ComForCare’s professional caregivers. We provide compassionate, non-medical home care with our transitional program, designed to support seniors after a stay in the hospital or rehabilitation facility. We will help your clients to feel confident that their loved one will be able to recover from the comfort and safety of home. 

Pillar 1: Clinical Coordination & Advocacy

• Discharge Review: We obtain and review all hospital discharge instructions to incorporate them into a personalized, non-medical care plan.
• Professional Liaison: Our care managers act as a bridge between your family and the hospital discharge planner or community health teams (such as AHS or Ontario Health).

Pillar 2: Medication & Condition Safety

• Adherence Support: We manage prescription pickups and provide strict medication reminders to prevent missed doses.
• "Red Flag" Monitoring: Our caregivers are trained to identify early warning signs for chronic conditions like COPD, Diabetes, and Heart Failure, flagging potential issues before they require an ER visit.

Pillar 3: Home Environment Stability

• Safety Audit: We perform immediate home safety assessments to identify trip hazards and implement fall prevention strategies.
• ADL Assistance: We provide essential support for Activities of Daily Living (ADLs), including bathing, grooming, and nutritious meal preparation, reducing physical strain during the recovery period.