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What You Need to Know When You’re Going Home from the Hospital

If you’re admitted to the hospi-tal, the medical staff will take care of your medication, your tests and even your meals. But when you go home, you’re in charge. It’s a lot to be responsible for, especially when you’re not feeling your best.

That’s why THIPA provides Care Management. Our care management nurses, social workers, gerontolo-gist, health coach and coordinator staff are available to help you receive the care and support you need during hospitalization and after your discharge.

“We have an in-patient care management team that is involved in a member’s acute care plan while the member is hospitalized. Upon discharge, our ambulatory care management team takes over. Our job is to ensure that the doctor’s plan of care is executed so the member can get better,” explains Janette Spring, RN, Ambulatory Care Management Manager.

Every THIPA member is assessed for ambulatory care management ser-vices while in the hospital. Members with multiple chronic conditions and those with a log or difficult hospital stay, are the members that benefit most from ambulatory care manage-ment after hospitalization.

“How we help a member upon discharge really depends on a member’s needs,” says Janette. “If a member has heart disease our health coach can discuss daily manage-ment to avoid another hospital stay. If there’s a hip fracture a member might need a visit with a social worker to help arrange in-home support since they won’t be able to prepare meals for a while. We also help arrange for medical equipment and can coordinate follow up doctors visits more quickly.”

“The most important thing that we want our members to know is that we’re not trying to rush them out of the hospital or tell them what to do or make decisions for them,” explains Janette. “Our goal is to align ourselves with the member’s goals. Whether the member wants to recuperate at home or in a skilled facility, we do our best to ensure their needs are met.”

THIPAs Care Management team empowers members to better manage chronic conditions by providing health education, in-home support and help coordinating doctors appointments and medical equipment.

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