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Rush University Medical Center studies program to help older adults transition from hospital to home
Date:7/28/2009

ial workers involved have found several common themes in post-discharge care. Patients reported difficulty getting around after discharge, particularly if their illness affected their mobility. Patients also reported difficulty scheduling medical appointments and getting to their physicians' offices, and delays in home health care services. Caregivers were often overwhelmed.

In other programs to help patients transition from hospital to home, nurses coordinate the after-hospital care, but Golden believes that social workers are ideally trained for the role.

According to Golden, research has shown that 40 to 50 percent of hospital readmissions are linked to social problems and lack of community services issues that social workers are trained to address.

"Social workers possess extensive knowledge of community resources, expertise in navigating complex social systems, experience using a framework of practice that focuses on the person in the environment, and training in case management and care coordination," Golden said. "Social workers are also able to use psychosocial assessment skills to explore family dynamics or resources that may affect the success of the discharge plan."

In its efforts to find new ways to help patients transition from hospital to home, Rush is also participating in Project BOOST (Better Outcomes for Older Adults through Safe Transition), a national project involving 30 hospitals to redesign the discharge process. Rush is the only hospital in Illinois included in the project. Like Rush's enhanced discharge planning program, Project BOOST, sponsored by the Society of Hospital Medicine, is aimed at reducing readmissions.


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Contact: Sharon Butler
Sharon_Butler@rush.edu
312-942-7816
Rush University Medical Center
Source:Eurekalert

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