1.  What is Transitions To Home?

Transitions To Home is a transitional care program designed to “bridge” the gap from the point you transition from one medical environment to home. We are designed to be responsive to your healthcare needs as we work and collaborate with home health and your primary care.


2.  How can Transitions To Home help me?

Transitions To Home offers a true continuity of care. We are in place to manage your healthcare until you are reestablished with your primary care physician. We help you to stay on a healthy track and prevent rehospitalization.


3.  Can home health not do the same thing as Transitions To Home?

No. Your Transitions To Home provider prescribes the orders for home health and other ancillary companies.  Your home health company carries out those orders. Transitions To Home insures you are cared for properly until you see you primary care provider after transitioning from the medical environment to home.


4.  Does Transitions To Home take the place of my PCP?

No. Transitions To Home is in place only to “bridge” the gap until you see your PCP again. If you do not have a PCP in place, we will make an introduction to a PCP who will fit your needs.  We will remain your provider until this is established.


5.  How do I enroll in Transitions To Home?

Before transitioning to home, a staff member from the facility where you are will ask you if you would like to be enrolled. If you elect to do so, a care liaison will visit you and further explain the program. The care liaison will also set your appointment before leaving the facility. You will know exactly what to expect upon their arrival.


6.  Is there a cost for Transitions To Home services?

Yes. Medicare covers this visit just as it would a visit to your PCP.


7.  Does Medicare approve Transitions To Home?

Yes. This is an approved Medicare service.  It is part of your Medicare part B benefit.


8.  Will Transitions To Home send all updates to my PCP or specialist?

Yes. We will partner with your PCP to insure the office is up to date on your healthcare management.


9.  What is included in my Transitions To Home visit?

A thorough examination is offered in addition to medication reconciliation, safety evaluation, home health management, and personal care evaluation. We are present to meet your healthcare needs while keeping you on a healthy track to wellness.


10.  What are the goals for Transitions To Home regarding my care?

The number one goal of Transitions To Home is to help keep you healthy and reduce hospital readmissions.