Transitional Care Program

Transitional Care Program

The Laurels of University Park places great value in our ability to make a guest's transition through the health care system as comfortable and beneficial as possible. The Laurels Transitional Care focuses on the coordination and continuity of healthcare from hospital to home. The Laurels of University Park has partnered with a number of hospitals, physician groups and home health agencies in developing this program.

In addition to direct care nurses, The Laurels utilizes dedicated and experienced RNs (Nurse Navigators) to oversee the intake of clinical information from the hospital, perform timely admission assessments, care plan development and guest education to ensure a safe discharge home. The Laurels of University Park physicians provide in-house coverage at least five days per week. The Nurse Navigators and The Laurels enhance physician coverage, identify and respond to any clinical issues that could result in slowed progress or a hospital readmission. The Laurels is among 5% of U.S. nursing facilities utilizing COMS Daylight IQ clinical assessment software. This cutting edge tool has allowed users to reduce returns to hospital by 40% and will assist The Laurels in reducing its hospital returns even further.

The Laurels of University Park therapists are available seven days per week to maximize each guest's recovery. Prior to a guest going home, The Laurels Transitional Care staff will perform a home assessment if appropriate, and identify any equipment or modifications that would enhance the guest's recovery or safety. Guest and family education is geared toward the specific diagnoses of the guest. In addition, The Laurels will coordinate with the guest's home health care company and contact the family physician to make sure all follow-up care is scheduled.