Transitions In Care & Bridge Program
Home Health Care Specialty Programs
At MetroWest, we offer two innovative home health programs to help bridge the gap for those in a transition, either from hospital to home or after being diagnosed with a life-limiting illness.
Transitions in Care
This program is offered to help you or a loved one transition from hospital to home. You’ll work with a Transition Care Coach to ensure a successful transition. Your Transition Care Coach is a registered nurse who will meet you in the hospital and follow up with you at home for 30 days to guide you through your transition.
You’ll also work with telephonic care, which follows up with you four times over the first 30 days you’re home from the hospital and works to answer any questions you have. You’ll also get a better understanding of your disease, have an open discussion of your wishes and goals and receive treatment for pain, shortness of breath, fatigue and nausea with help from you palliative care team.
The Bridge Program is a specialty program aimed toward patients who aren’t psychologically ready for hospice care, but have been diagnosed with a potentially life-limiting illness and are receiving curative or palliative care.
We work to help patients through some of the unique psychosocial and spiritual issues that may arise at this time. Patients in the Bridge Program must be homebound except for doctor or treatment visits. No certification is required for this program, and it is typically covered under the home care benefit of your insurance plan.
Both Transitions in Care and the Bridge Program are complimentary services. If you’d like more information, please ask us at MetroWest or call us at (508) 383-7000.