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Transitional Care

AT Home Care provides family members and loved ones with several levels of attentive and compassionate care services in the home setting.

What is Transitional Care?

Transitional care addresses the needs of patients in a declining state of health who are not yet ready to enter hospice care. Patients may continue to receive life-prolonging treatments in additional to palliative care that focuses on comfort measures and pain relief. Many studies have shown that palliative therapies can have a positive effect on a patient’s mobility, happiness and overall quality of life. Our experienced transitional care staff offer your loved ones the opportunity to experience joy and relief from pain as they navigate the final stages of life.

Transitional Care is specialized medical care for people with advanced illnesses. Its focus is to provide patients with relief from the symptoms, pain, and stress of an advanced illness regardless of the diagnosis. The goal of AT Transitional Care is to improve the quality of life of both the patient and their support system. Palliative services are appropriate at any age of life and at any stage of an advanced illness. The services provided by AT Transitional Care can be provided in addition to aggressive treatments and curative procedures.

Transitional care focuses on:

  • Improving your quality of life – physically, mentally, and spiritually
  • Reducing pain and/or treatment side effects
  • Understanding your illness and making decisions that are best for you
  • Communicating with your doctors and healthcare team, and also your loved ones

Who is a part of the Transitional Care Team?

Your care is provided by the following health care providers in whatever setting is necessary for your particular illness:

  • Transitional Care Doctors
  • Nurses
  • Social Workers
  • Chaplains
  • Occupational Therapists
  • Speech Therapists
  • Physical Therapists
  • Pharmacists
  • Volunteers

Our services include:

  • On-Call Hospice Support – 24 hours a day, 7 days a week
  • Pain Management – Treatments to help with pain and discomfort
  • Symptom Management – Treatments to aid with anxiety, breathing, nausea and other symptoms
  • Medication Coordination – Allows proper medication to be available when needed
  • Registered Hospice Nurses Visits – Scheduled to meet your individualized hospice nursing care plan
  • Nurse Aide Visits – Scheduled to aid with personal care: bathing, feeding, dressing and other duties
  • Hospice Team Visits – Hospice counseling, program implementation, insurance coverage, support and follow-up visits
  • Volunteer Visits – Scheduled for companionship, errands and light duties
  • Bereavement Services – 13-month bereavement services post-death to all family members and loved ones

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