Hospital2Home

Because their thinking problems are not accounted for in their care, 40% of Medicare beneficiaries who are admitted to hospital who have a dementia diagnosis in their medical record return within 30 days, compounding an acute care stay into a full-blown crisis for patient and family.  Hospital2Home is a program that supports adults with memory loss and their caregivers during the care transition from hospital to home. This program is delivered by social workers who provide in-person and telephone follow-up, caregiver coaching and short-term care coordination for recently discharged patients.

Cognitive Solutions LLC provides program development consultation to community-based organizations to add a dementia specialty to care transitions work they may already be doing, delivered by program managers currently running this program successfully, including building sustainable funding.

The Benefits?  A unique dementia care service that produces

• BETTER health outcomes
• REDUCED re-hospitalizations
• ENHANCED care coordination
• IMPROVED medication management
• MEDICAL stability—short and mid term
• DECREASED caregiver burden

For more information contact msplaine@cognitivesol.com   443-630-9226