transitional care planning

Transitional care planning is the process of preparing and coordinating a person’s healthcare as they move from one setting to another, such as from hospital to home or a care facility. It involves assessing individual needs, arranging necessary services, communicating with new caregivers, and providing education to ensure a smooth and safe transition. The goal is to prevent health issues or hospital readmissions by ensuring continuity of care, guiding patients and families, and supporting recovery or ongoing health management during these important changes.