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Transitional Care Programs and Services


Transitional Care Programs and Services

Intensive Post-Acute Rehabilitation

Individuals entering rehabilitation are always unique, but their primary objective is typically the same – a return to health, home and what’s important in life, as soon as possible. At Touchpoints Rehab, part of the iCare Health Network, we understand.

Our innovative, personalized program is designed to accelerate the recovery process, so that patients can Get Well, Live Well and Be Well, faster, better and with fewer challenges than any traditional rehabilitation program. These programs are designed to optimize therapy, promote recovery, and provide ongoing quality of life for patients experiencing chronic and high acuity medical conditions. 

What is Transitional Care?

Touchpoints Rehab is a leader in this field. Transitional Care uses a team of healthcare providers including nursing, respiratory and other staff to closely monitor a patient’s health status from setting to setting. This team will guide care from the hospital to the skilled nursing facility and into the home ensuring a smooth transition from one to the next. You will often see the same nurse or team member in the hospital, in the facility and following up after discharge to ensure success and avoid readmission to the hospital.

The Care Transitions team works with physician guidance and alongside APRNs, Physician’s Assistants and the entire staff of the skilled nursing facility. The team focuses additional focus and resources on patients with complicated medical conditions who are at risk for frequent hospital admission.

Care Transitions Team

  • Care Transitions Nurse Liaisons
  • Care Transitions Respiratory Therapist
  • Multi-disciplinary clinical team
  • Consulting physician specialists, PAs and APRNs

Addressing Frequent Hospitalizations

The program also addresses repeat hospitalizations by applying frequent lab work and assessment, integrated specialty care including pulmonary/respiratory therapy and sleep medicine, specialist consultation, clinical partnerships and more.

For patients with multiple hospitalizations the team will address their general state of health and wellness and improve their daily functionality. This will get them back home where they want to be and slow the tide of re-hospitalizations.
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Care Transitions Clinical Programs

Program Highlights

Some patients who have been hospitalized following these conditions may be encouraged to stay in a post-acute facility to regain their strength. Our network partnerships ensure that our patients receive rehabilitation services in close collaboration with their medical team within the hospital networks. The key features of this unique approach include: 

  • The Touchpoints Rehab team has been trained by the hospital network team. The clinical team follows their established protocols.
  • Touchpoints Rehab has experienced physicians and physician extenders.
  • The Touchpoints Rehab team includes a dedicated Director of Care Transitions who follows caseload patients through the course of their care, including after discharge home and provides additional, continuous clinical over- sight and support. 
  • The hospital and Touchpoints Rehab teams remain in continuous communication, working together to ensure a smooth transition. In addition, the hospital team remains informed on the progress of patients’ post-acute stays on a daily basis and continuing through discharge home. 
  • Once discharged, patients are reconnected with their primary care provider.
  • Touchpoints Rehab staff are skilled in the delivery of all IV treatments and modalities.  

Program Benefits

  • Consultations and daily communication with the hospital team ensure continuity of care and optimal treatment decisions.
  • Careful oversight of progress and a quieter, more personal environment are highly conducive to rapid improvements.
  • Individually paced rehab programming enables faster recovery, stabilization and restoration of strength.
  • Ongoing specialty evaluations
  • Diagnosis-specific education for you and your family
  • Healthy menus tailored to your diagnosis.
  • Weight monitoring
  • Physical, occupational and speech therapies
  • Customized care planning
  • Home support and discharge planning
  • Weekly rounds by hospital practitioners
  • IV Lasix, Bumex, Dobutamine and Milrinone therapies
  • Weekly lab value monitoring
  • Touchpoints Rehab locations in Bloomfield, Manchester, East Windsor and Farmington.

For more information, please call (860) 812-0788, email or visit us online at www.touchpointsrehab.com

 

News & Updates

Discover the latest from our blog

  • March 13-17, 2023 is National Long Term-Care Administrator’s Week. During this week, staff, residents, families, and volunteers have the opportunity to say “thank you” and honor the administrators who lead our nation’s long-term care communities.  A heartfelt and sincere thank you from all of us at iCare Health Network to our dedicated Administrator team who continues to lead through challenging times and work tirelessly to safeguard and enrich the lives of the residents we serve. 
  • On March 3, 2023 the team at Touchpoints at Bloomfield celebrate Read Across American Day and Dr. Suess’ Birthday. In honor of the two occasions, The Cat in the Hat and Thing One and Thing Two made a special visit and the whole team made sure to look the part.  The event highlighted the importance and joy of reading and, as always, ended with a special treat and dancing. Read Across America is the nation’s largest celebration of reading. Great work, TAB team! 
  • On February 24, 2023 Parkville Care Center and the iCare Health Network team held a Remembrance Ceremony to mark the 20th Anniversary of the Greenwood Nursing Home Fire.  On February 26, 2003 a fire broke out at the then Greenwood Nursing Home at 2:40 AM. Eventually traced back to a resident room, the fire claimed the lives of 16 and injured an additional 23 people. Those who died ranged in age from 18 to 76 and all were from the greater Hartford area. It was six degrees at that time on that …
  • February is designated as American Heart Month to bring attention and awareness to the prevalence and severity of heart disease as a leading cause of death for Americans in the United States. The team as Touchpoints at Bloomfield wore red on February 3, 2023 for National Wear Red Day, the first Friday of every February.  Some iterations of National Wear Day are to promote awareness of heart disease in women. This is because, according to the American Heart Association, cardiovascular disease …
  • January 23-27 is National Activities Professional Week with a theme of “Adventure Awaits”. On this week we celebrate all of iCare’s Therapeutic Recreation and Activities Professionals as they bring enrichment, fun, engagement and fulfillment to our residents’ lives.  According to the National Association of Activities Professionals Website, these teams are part of a vitally important profession that helps people live a life that is full of fun and meaningful activities.…
  • On January 20, 2023 a group from East Culture Arts Group performed traditional dances and songs in celebration of Chinese New Year.  According the their materials, East Culture Arts seeks to increase awareness and understanding of Chinese and other country’s cultures; promoting cultural exchange through singing, dancing and other activities involving the arts. China is home to 100 dance styles, representing fifty-six different ethnic groups, including the Han. Every dance has its own dis…
  • There are so many deep and meaningful quotes attributed to Dr. Martin Luther King, Jr. that resonate strongly for those in healthcare and in daily service to others. But it is important on this day to remember what a life of service to others means. That loving one another is even more important in times of strife, discord and division. That words alone will not solve problems or save lives, but it is in your actions, big and small that you legacy and impact will be decided.  Today, go forward…
  • Parkville Care Center was in the holiday spirit this year with festive attire all month long. The month of December was full of special outfit and attire days like Cozy Toes, Silver Bells, Winter Wonderland, Rudolph Red Wear, Jolly Jeans and more.  Santa came to visit the residents, passing out gifts to all. Meanwhile staff enjoyed a tasty holiday lunch with music, raffles and plenty of merriment!  Now dash away all!