Your health care team will work with you to understand the challenges you have after your hospital stay. This will help your team work toward a plan to make sure you have the right care and support to help manage your health after you leave the hospital.
You and your family member or caregiver, along with members of your health care team will meet to talk about your care. This is called a transition conference.
The goals of the transition conference are to help:
You and your family member or caregiver will meet with the doctor taking care of you in the hospital, and the social worker or case manager.
Other members of your health care team may also be invited.
A caregiver is a family member or someone who helps you with activities such as:
If there are other people you would like to attend the transition conference, tell the social worker.
The transition conference may take place in person, over the phone or by video conference.
Together, you and your family member or caregiver will talk with your health care team about:
Ask that members of your health care team answer all of your questions and concerns using plain language.
After the transition conference, a summary of the meeting will be put in your medical record. You will receive a copy.
Your health care team will work closely with you and your family member or caregiver to coordinate your transition from the hospital.
Here are some things to think about as you plan to transition from the hospital:
Health's Patient Education Department, Your Care Plan After Leaving the
Health's Patient Education Department experts
Call the Senior LinkAge Line at 1-800-333-2433.
Call 711 or 1-800-627-3529 (TDD).
Or call 1-877-627-3848 (speech-to-relay service).