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Transitional Care

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Transitional Care

Barrett Hospital & HealthCare’s Transitional Care program provides extra attention and clinical expertise, guided by your therapeutic goals, to improve health and independence after a major surgery, serious illness, or severe injury.  With Transitional Care, you can recover in your community, so you are closer to family, friends and loved ones while having access to a full range of hospital resources such as providers, nurses, therapists, lab services and diagnostic imaging not available in many other care settings.

There are a wide range of conditions that may benefit from Transitional Care.

Some examples include:

  • Stroke

  • Hip or knee replacement

  • Major surgery

  • COPD and other breathing conditions

  • I.V. therapies for infection or other conditions

  • Injuries such as fractures from falls

  • Renal Disease

  • Neurodegenerative Disease

  • Wounds

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What is Transitional Care and How Does it Work?

Transitional Care is a specialized program for patients who no longer need to be in a traditional acute care hospital but still may benefit from additional skilled medical care, nursing care, or physical rehabilitation services.  This may include education regarding a new treatment that will be needed at home, adjusting or finishing certain treatments under the supervision of nurses and medical providers, or performing exercises with therapist to help you regain enough strength, functionality, balance, and range of motion to be independent with confidence. 


Most patients who live at home before their Transitional Care stay will return home after.  Of course, every patient is different, and some patients’ illness, injury, or surgery may require a more supportive living situation.  However, our team strives to keep every patient as independent as possible.


Even if your hospitalization occurred elsewhere, you may still qualify for our Transitional Care program.  If you are hospitalized at another medical facility and could benefit from some additional recovery, a discharge planner from that facility can assist in possibly arranging for you to come to Barrett Hospital & HealthCare Transitional Care.  We’ll work with the other hospital to make sure our program is the right fit for you at that time based on your needs, insurance coverage, and other considerations.  


We have a team of healthcare professionals working together to create an individual treatment plan that will meet each patient’s recovery needs and goals.  Key team members meet with patients and families daily during team bedside rounds.  Your team may include: 

  • A dedicated hospital provider (Hospitalist)

  • Other medical specialists as needed

  • Hospital-prepared Registered Nurses supported by additional education

  • Physical, Occupational, and Speech & Language Pathology therapists

  • Respiratory therapists

  • Registered dietitian

  • Disease and Medication management support by experienced Pharmacists

  • Discharge Planning coordinators

  • Wound Care

Our Transitional Care team works in concert with you and your family to offer well-coordinated care that:

  • Maximizes patient outcomes

  • Reduces the risk of having to go back to a traditional hospital setting

  • Ensures coordinated follow-up with patients’ regular (primary care) providers and specialists 

Transitional Care Patients Benefit From: 

  • Regular bed-side rounds with their care team

  • Two to three times more hours of Registered Nurse staffing per patient each day than other post-acute settings; more relaxed, flexible care setting than most large hospital facilities

  • Onsite Emergency Room and 24/7 hospital services in case of emergent health changes

  • Activities and education designed to meet unique needs​

  • Quality care recognized by National Rural Quality Awards 

We’re ready to help you or your love ones recover. Contact a care coordinator today at:  406-683-3140. If you are a referring hospital and seeking admission for a patient contact 406-683-3140.

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