Transitional Care

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

You may work with 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

Communication plays a key role when it comes to transitional care. Our team will help you and your loved ones communicate with your primary physician to manage any symptoms or treatment side effects that you may be experiencing. The team works in partnership with your own doctor to provide an extra layer of support for both you and your family. Not only does the AT Transitional Care Team provide you with extra time for communication, we are also experts in symptom management and provide you with the assistance needed to navigate the healthcare system.

The AT Transitional Care Team provides you with the support needed to carry on with your daily life. The goal of transitional care is for you to experience the best possible quality of life. Our team will help you better understand your condition and your options for medical care. You can expect us to assist you with the following needs that you may encounter:

  • Treatment Options
  • Emotional Challenges
  • Goals and Desires
  • Physical Side Effects
  • Advanced Directives

Transitional care may be appropriate for you if you suffer from pain, stress, or other symptoms due to an advanced illness. Illnesses may include but are not limited to: cancer, cardiac disease, respiratory disease, kidney failure, Alzheimer’s, HIV/AIDS, ALS (i.e. Lou Gehrig’s disease), and multiple sclerosis.

Even though transitional care services are provided during any stage of an illness, there are some “triggers” that may aid in your decision to begin using our services. The following are “triggers” that may assist you in determine the timing of when you may be ready for AT Transitional Care:

  • Multiple falls
  • Multiple infections
  • Frequent hospitalizations
  • Physical decline (e.g. fatigue, decreased ambulation, use of a mobility device)
  • Multiple chronic health conditions