Post-Acute & Geriatric
Charter Health’s Post-Acute & Geriatrics team partners with several skilled nursing facilities to deliver rehabilitation and geriatric medicine, which include a group of nurse practitioners and physicians. Our provides medical coverage 5 days a week (Monday – Friday) and at least one weekend day. Our patients comprise of permanent residents of nursing homes and short-term rehabilitation patients who need improvement on their functional status prior to discharging home.
Short-term rehab patients typically have been transitioned to the facility from a hospital after a serious medical or surgical event, and require ongoing medical care and therapy before discharging home in a safe condition. While others have multiple chronic conditions that require close monitoring. Charter’s primary goal is to safely transition these patients from hospital to rehab and from rehab to home.
During the time of admission into rehab, our team will perform an in-depth review of the patient’s hospital course, past medical history, and hospital discharge orders. We then create and complete a detailed medical plan of care and visit with patients an average of three times per week. Staff will then document our care plans and recommendations in the electronic medical record EPIC, and use it to communicate with each patient’s primary care physician and others on the care team.
During the COVID-19 pandemic, our post-acute team courageously remained on the front-lines for our patients and nursing home partners. It was a physically and emotionally exhausting trial, but we prevailed! We had decided early on we needed to be at the bedside for these most vulnerable citizens and simply could not do this over the phone or by video. Therefore, we increased our staffing and our patient encounters that needed to increase significantly during the peak of the crisis in April, May, and June. For instance, in April we entered a new facility to help create a dedicated COVID-19 recovery center, which for 14 weeks accepted only COVID-19 infected patients from Boston area hospitals. We’re proud to have such a dedicated team that saved lives and relieved so much suffering.
Charter Health partners with the following rehabilitation and skilled nursing centers:
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