What is Transitional Care?
Transitional Care is a specialized service for patients no longer needing
a traditional acute- care hospital but are not ready to return to home.
These patients still require additional skilled medical care, nursing
care, or rehabilitation services.
Admission Inquiries:
Amy Dreesen, RN, BSN
Phone: 406-846-7730
Fax: 406-415-1042
akdreesen@dlmed.org
Our team is equipped to care for patients with complex needs, including:
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After Surgery: Cardiac, neuro, orthopedic, abdominal, and more
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Respiratory: Specialized treatment and support of respiratory therapy
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Wound Care: Special attention and skill for wound healing
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Intravenous (I.V) Antibiotics: To treat a variety of infections
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Specialized Therapy: Including physical and speech therapy
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Teaching and Training: Education on management of new procedures or medication management (i.e.
new peg placement, newly diagnosed diabetic, new ostomy, heart failure)
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Coordination and Ongoing Assessment of Complex Plans of Care: RN oversight and team collaboration to modify care plans as frequently
as patients need
Why Deer Lodge Medical Center?
Our program is supported with evidence – based best practices through
a partnership with Allevant Solution developed by Mayo Clinic and Select
Medical. Our program is called Transitional care because it is a model
focused on healing patients transition from a hospital stay to their highest
level of independence at home or in another setting. We use hospital-
level resources, team processes, best practices, and extra clinical education
to support this “transition.” Since most patients receive
this care under Medicare, this level of care is sometimes also referred
to as “Swing Bed.”
We provide:
- A personalized plan of care
- Bedside rounds that engage you, your family, and your care team to help
you reach your goals
- Hospital-level nursing staff to keep you safe and help you recover
- A home-like environment that accommodates family and participation in activity
and rehabilitation
- On-site physicians, therapy, radiology, and laboratory that will address
your specific needs
How do I qualify for Transitional Care?
- Have at least a consecutive three-night qualifying stay as an acute care
patient within the last 30 days
- Require a skilled need such as physical therapy, speech therapy, nursing
therapy, teaching and training, medication management, observation and
assessment
- Medicare A & B; other types of insurances need pre-authorization, but
our team can help determine if you qualify under the Medicare guidelines
Outcomes: (January 2018- December 2019)
Average length of stay is 17 days
63% of patients return to home independently
9% of patients were readmitted to an acute facility less than 30 days
4.5 out of 5 people would recommend this program
Patient Success Stories:
Kenny Fleming's TCU Experience
Don Cappa's TCU Experience
For more information, please contact our
Transitional Care Nurse Coordinator, Amy Dreesen, RN, BSN
at (406)-846-7730 or akdreesen@dlmed.org
