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Hospital to Home

Reducing Hospital Readmissions

Ready-Set-Go Home is a transitional care program that is designed to help seniors make a successful transition home after hospitalization. This program includes a three-prong approach for reducing hospital readmissions: a major risk for seniors in the month after a hospital discharge.

Among seniors on Medicare, roughly 20% of discharged patients end up back in the hospital within 30 days of being sent home. Elderly adults have a much lower chance of recovery if they are re-hospitalized in this 30-day window, which is why reducing hospital readmissions is so important.

Specialized Nursing Services is committed to reducing hospital readmissions through our Ready-Set-Go Home program. Ready-Set-Go Home provides care recipients with skilled, non-medical home care during the period following a hospital discharge. We’ll help you coordinate your loved one’s transition home, assist your loved one during this transition, and support your loved one through their first weeks home from the hospital.

Three-Prong Approach to Reducing Hospital Readmissions

The vast majority of preventable re-hospitalizations could be avoided by following doctors’ orders. But after a serious injury or illness, even the most basic tasks can be difficult or impossible for elderly adults. For seniors to follow doctors’ orders during this period, they need extensive outside support.

Our Ready-Set-Go Home program is designed to give seniors this much-needed support, increasing the odds of a full or partial recovery and reducing hospital readmission risks. We provide our non-medical services in accordance with medical directives and in conjunction with care provided by clients’ family and friends. Our services are customized for every client, ensuring your loved one receives care tailored to their specific needs.

The Ready-Set-Go Home program uses a three-prong approach for reducing hospital readmissions:

  1. At the Hospital. Our Ready-Set-Go Home program starts during your loved one’s hospitalization. Our caregivers can visit your loved one at the hospital and provide support services for family and friends. When doctors begin to discuss your loved one’s discharge, we can guide your family through the discharge process and provide valuable information on discharge planning. Our “Ready-Set-Go Home” guide includes detailed information on hospital discharges, questions you can ask doctors and nurses during this process, and tips on reducing hospital readmission risks.

  2. At the Client’s Home. After your loved one’s discharge, our caregivers will provide skilled, non-medical assistance to ensure your loved one’s safety and comfort during recovery. Meanwhile, we act as the “eyes and ears” in the home. Our caregivers can help spot changes in your loved one’s physical or cognitive health, and we know the reasons why many seniors skip follow-up doctors’ visits, miss medication doses, or otherwise fail to follow proper recovery protocols. If family and friends are acting as unpaid caregivers, our services can help them manage these responsibilities and avoid becoming overwhelmed.

  3. At the SNS Nursing Office. Behind the scenes, the Specialized Nursing Services office will support your family and your loved one’s caregivers. Our office has access to tools for reducing hospital readmissions by identifying clients at high risk of re-hospitalizing. Specialized Nursing Services staff can provide medication and appointment reminders, accompany your loved one to appointments, and help you coordinate medication, equipment, and food deliveries.
Do you have a loved one who will require home care services after an upcoming hospital discharge? Contact Specialized Nursing Services today to learn more about our Ready-Set-Go Home program for reducing hospital readmissions and to request a free consultation from your local office.

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We understand that choosing an aide to help with elder care services is a personal decision and can be intimidating. We would like to introduce our company and services by offering four hours of Private Duty Services. Our goal is to provide excellent elder home care and demonstrate how we can customize our care to your needs. We offer a complimentary, no-obligation demonstration of our Private Duty Services so that you can get to know us. Specialized Nursing Services provides an aide that will come to your home for four hours of care.

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Contact one of our home healthcare professionals or contact us via this page. We are available to speak to you seven days a week.

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