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Transitional Care & Rehabilitation

Short-term care for patients transitioning from hospital to home.

What is Transitional Care?

Transitional Care is for patients who are ready to be discharged from a traditional acute care hospital but aren’t quite ready to go home. These patients still require additional skilled medical care, nursing care, or rehabilitation services.

Why Choose Us?

  • Patients are close to their community of friends and family, and still receive the appropriate treatment they require for their specific condition.
  • Patients receive 24-hour care from our experienced medical, nursing and rehabilitation staff.
  • We assist patients in reaching their maximum level of independence prior to returning home.

Understanding Transitional Care

  • Transitional Care is a Medicare program that allows patients to receive skilled medical care when acute hospital care is no longer required. Skilled and rehabilitative care improve patient healing and are more effective in returning the patient to prior levels of activity.
  • Often referred to as “swing” care, the program easily allows a patient to move between different levels of care with the continued support of a comprehensive team of care providers. For example, someone who needs skilled physical therapy after joint replacement surgery before returning home.
  • Transitional care following a long illness or surgery is provided in various settings, from hospitals to nursing homes. It is the patient’s choice to decide where they receive care. Most patients and families prefer to receive care that is close to home, friends and family so that emotional support is convenient.
  • This is a short-term rehabilitative program. A typical length of stay is 1 – to – 2 weeks, but sometimes 3 weeks of care is most appropriate. Patient recovery is the primary goal so that they can return home.


Key Features

Broaddus Hospital

  • 24 hour Physician as well as Nurse Practitioner onsite
  • Physical, Occupational & Speech Therapies
  • Therapy provided two times per day
  • Emergency Medical (24 Hours) and Hospitalist Services
  • Certified Wound Specialist
  • Rehab Services onsite for in-room and/or gymnasium setting therapy
  • IV Therapy [including long term antibiotic treatment]
  • In-house Respiratory, Lab, X-Ray, Pulmonary and Dietary services
  • Discharge Planning/Social services.
  • 24 hour Registered Nurse staffing with excellent staff-patient ratios.
  • Quiet, Relaxed Environment
  • Average Stay Is 14 Days
  • Daily Skilled Nursing Care
  • Shorter length of stay than a Nursing Home

Webster Memorial Hospital

  • A personalized plan of care.
  • Regular Care Team Rounds involving you and your family.
  • Hospital level nurse staffing to keep you safe and meet your needs.
  • Promotes a home-like environment accommodating family and individualized activity programs, as well as therapy in several environments.
  • Our on-site physician, therapy, radiology, laboratory and pharmacy teams will address all your medical needs.

Our Team

is especially equipped to meet the needs of even the most complex patients.

After Complex Surgery
Cardiac, neuro, orthopedic, abdominal and more

Respiratory Needs
Specialized treatments and support

Wound Care
Special attention for wound healing

Intravenous (I.V.) Antibiotics
To treat a variety of infections

Specialized Therapy (Broaddus Hospital)
Including physical, occupational, speech and respiratory, and an array supportive services

Specialized Therapy (Webster Memorial Hospital)
Including physical, respiratory, and an array of supportive services


What if my surgery is done at another hospital?

Regardless of where your surgery or inpatient care is received, your follow up care can be received here. Transferring to our program is easy.

Follow these steps:

Inform your provider or case manager that you wish to receive transitional/rehabilitative care at Webster Memorial Hospital.

Your transfer will be coordinated by case managers from both facilities including medical records, medication information, and transportation.

You/your family will receive a call from a case manager to confirm your arrival and pre-register your stay.

Resource links

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