Restorative Transitional Care for the Elderly – BrightStar Care

Posted on May 13, 2012


Often, elderly clients recovering from surgery and transitioning from a hospital or skilled nursing facility back to home require additional support.  The client’s physical challenges coupled with the time constraints and long travel distances of family members make the road to recovery difficult.  While the discharging facility nursing and support staff provide written discharge plans and review them with the client, it can be overwhelming on return to home, where nursing support is no longer a “call button away.”  This is where BrightStar truly shines!

Our registered nurse (RN) care coordinator steps into this void, providing a professional, compassionate, organized approach to assist with this critical transition.

A recently discharged client whose hip surgery required a short stay in a local rehabilitation facility returned home to find our BrightStar RN Care Coordinator ready to provide a comprehensive physical assessment and an individualized, holistic nursing care plan.  The home was assessed to assure a safe environment, free of potential obstacles and hazards.  Having already reached out to the Medicare Home Health Nurse to inform her BrightStar was onboard to provide additional support services, the care plan was prepared to coincide with the rehabilitative care plan prescribed.

The BrightStar live-in caregiver candidate was interviewed by the client, acclimated to the home, and has reviewed the care plan with the RN Care Coordinator.   The care plan will include encouragement from the caregiver to comply with the schedule of assigned exercises on the days the therapist is not present.  Medication management was reviewed with the client in addition to a schedule for home physical therapy and occupational therapy.  The RN Care Coordinator ensured there was a follow-up office visit scheduled with the client’s physician, and that there was support in place to safely transport the client to and from the office visit.

Three weeks after returning home from the rehabilitation facility, the client resumed independent living, having reached this goal with professional assistance and compassionate care provided by the BrightStar caregiver and RN Care Coordinator.

Our transitional, care managed approach can ensure your loved one makes a complete recovery to independent living.  Read more about our care managed approach on our range of care page.

BrightStar Care of Downtown Houston

BrightStar is an in-home health care company designed to help, give us a call at 832-730-1255.