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Hospital-To-Home Transitional Care Services

Coming home from the hospital is often a relieving — and exciting — time for individuals and their families. However, there are challenges associated with care transitions for older adults. These challenges might include a higher risk of falls, infection, medication mismanagement or hospital readmission.

At Corewood Care, we understand many individuals feel vulnerable during hospital-to-home transitions. Our compassionate care managers and caregivers specialize in making the hospital-to-home transition as safe, smooth and comfortable as possible. We offer transitional care services that enhance client safety, quality of life and health outcomes.

Click on a location below to see the areas we serve:

Maryland Washington, D.C. Virginia

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What Is Hospital-To-Home Transition Care?

Many older adults experience difficulties in self-managing their recovery following a hospital stay. At the hospital, they receive a high level of care from their medical providers, often getting detailed discharge instructions.

However, following these post-operative care instructions can prove difficult without adequate preparation or support. For example, it might be challenging for aging adults to manage their medications, communicate clearly with their physicians or monitor themselves for changes in their condition.

This lack of care planning and support post-surgery could cause adverse consequences or long-term health complications for aging adults.

What Do Corewood Care Hospital-To-Home Caregivers Do?

Our multidisciplinary team at Corewood Care offers transitional care services that support older adults during these vulnerable transitional periods. Our care managers research, coordinate and manage our clients’ care needs across the health care system so that they can focus on healing. We also develop custom care plans that facilitate a convenient, comfortable recovery.

For example, our care managers and aging life experts can assist older adults with the following services post-operation:

  • Discharge planning
  • Personalized care plans
  • Client education
  • Communication with physicians, care providers and relatives
  • Care research, planning and coordination
  • Chronic care management
  • Medication reminders
  • Transportation to follow-up doctor appointments
  • Personal care, including grooming and in-home mobility
  • Light housekeeping
  • Meal preparation
  • Nursing services

Is Hospital-To-Home Care the Right Fit for Your Relative?

Hospital-to-home care is beneficial for those returning home from the hospital or a skilled nursing home stay.

These services are also helpful for clients who require acute-level care or need help managing symptoms or pain related to chronic health conditions, including:

Congestive heart failure.

Chronic kidney disease.

Dementia or Alzheimer’s disease.


Parkinson’s disease.


Hypertension or high cholesterol.


Chronic Obstructive Pulmonary Disease (COPD).

Schedule a Free In-Home Assessment With Corewood Care

At Corewood Care, we aim to support elder adults during hospital-to-home transitions so they may thrive and live gracefully. If you are looking for dependable hospital-to-home care near Bethesda, Maryland, or Washington, D.C., contact the Corewood Care team today.

Our compassionate, multidisciplinary team oversees the client’s health from a bird’s-eye view to facilitate the safest, quickest recovery possible. We also use a state-of-the-art care delivery system that keeps family members and care providers informed. Families can access a client portal to review care plans, schedules and other relevant care information.

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Call us at: (301) 909-8117

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Call Us: (301) 909-8117