04/15/2026
Community Transitions 🏠
We help clients get home and stay home from hospital and long-term care stays. Our service is especially ideal for complex cases where limited or no family is involved or the family lives at a distance. We collaborate with hospital care managers to ensure the discharge plan is properly carried out and assist senior orphans as if they were our own family. Stepping in to coordinate care needs with long-distance family and facilitate communication between family, client, and healthcare providers to ensure appropriate quality care is our specialty. We follow-up post-discharge, including medication compliance, DME, and home health (OT, PT, ST) with continued patient education at home such as medication, precautions, equipment, etc. to tailor individual needs beyond just the basics. Coordinating other services (including non-medical) to lower client costs and implementing weekly programs to ensure client compliance and prevent re-admissions is key.
Care Navigators make our clients part of our family.♥️