OneCare aims to improve care delivered at home after a hospital stay and focuses on Congestive Heart Failure (CHF) because it is associated with a higher risk of returning to the hospital.
Knowing what happened in the hospital is the key to good care when a patient transitions home. We get started early: medications and discharge instructions are reviewed, equipment and resources are mobilized, and Five Star Home Health Care and Heal schedule care appointments at the patient’s home.
The first week home from the hospital has the greatest risks. We’re here to provide extra support to the patient and to their primary care doctor during their recovery. With a Heal doctor visiting at home within days of discharge and health services provided by Five Star Home Health Care, OneCare is designed to reduce the risk of unnecessary readmission to the hospital.
Chronic conditions benefit from a long term outlook. Doctors, nurses and therapists will be coordinated to teach the patient and their family how to manage symptoms. Nurse Aides assist with daily personal care, meals and medication reminders. The Heal Hub monitors vital signs remotely to provide an ongoing connection with medical professionals.