Adapt a transition of care program for the patient to a rehabilitation or skilled nursing setting.

When adapting a transition of care program for a patient to a rehabilitation or skilled nursing setting, it is important to ensure that all necessary steps are taken in order to provide the best possible outcome. This includes obtaining detailed medical records from their previous healthcare facility as well as arranging for any necessary specialist visits before transfer. Additionally, it is also essential to coordinate with the new facility ahead of time in order to ensure that they have an established plan ready upon arrival.

Furthermore, psychological support should be offered throughout this process especially if there are language barriers or cultural differences that need addressing. Moreover, clear communication between different members involved in the transition such as doctors, nurses, and family members must be established in order for everyone to stay on the same page regarding care plans and expectations.

Finally, educating patients about their condition prior to leaving will help them better understand what lies ahead so they can more easily adjust when arriving at their new home. All these measures combined will lead towards successful transitions of care allowing patients access much needed rehabilitative services during their recovery.