In early 2014 the Outpatient Therapies Department at Hebrew SeniorLife recently launched a service we call Therapy House Calls (THC), which delivers outpatient therapy services to patients in their own homes. Launching an innovative service is exciting enough on its own, but what really had me and my team thrilled, is the opportunity we discovered in HSL’s senior living communities to work collaboratively with specialists across disciplines to benefit our patients through a continuum of care. By doing so, I believe we are able to deliver the best care in the right place at the right time. Let me explain.
Unfortunately it is all too common for an older patient to be discharged home after an acute-care hospital stay with a referral for home health care, if needed, but little other support once the Home Health intervention ends. It is up to the patient, or a family member to figure out, and then coordinate, appropriate post-acute care.
Now imagine going home where your primary care provider is located right in your community, steps away from your home and has access to a coordinated network of social workers, home health and private care providers. Take it a step further, and my team can bring therapy in when the patient is no longer homebound, but could use additional therapy.
Experience has taught me that often making the transition between one care environment to another leaves older patients and their families feeling particularly vulnerable. By working cooperatively together with the patient’s best interest at heart, I believe a well-coordinated continuum of care network can help the ever-growing population of older adults live healthy and productive lives.
Breaking down boundaries between disciplines is key, and we are doing that one step at a time in Hebrew SeniorLife’s senior living communities, providing a model that represents the future of senior care focused on transforming the experience of aging.
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