Transitional Care Unit
The Transitional Care Unit (TCU) is here to provide you with special care in a residential setting as you make the transition from the hospital back to your community. The Transitional Care Unit is primarily a short-term care facility. Your length-of-stay will be based on your recovery and progress, physician’s judgment, and regulatory requirements. Although the Transitional Care Unit is a part of Passavant Area Hospital and shares many of their services, it is not a hospital. Consequently, you may often be referred to as a “resident” rather than a “patient.”
YOUR PLAN OF CARE
Your physician and a dedicated team of professionals will be working closely with you to implement a plan of care that will help you reach the health goals established by you and the team. We are committed to making your stay here as comfortable as possible and to help you obtain your optimal level of physical, emotional, and spiritual health.Members of our interdisciplinary team include:
- A Clinical Director and Nurse Manager coordinate the operation of the Transitional Care Unit and assure that safe and effective care is provided to each patient.
- Your personal physician is responsible for your total care while you are a resident of the Transitional Care Unit.
- Your doctor may order consultation services from a variety of specialists, including dentists and ophthalmologists. A listing of these services is available upon request.
- Your physician is only required to visit weekly in TCU, but will be notified of any problems that occur.
- The nursing staff of the Transitional Care Unit gives individualized, consistent resident care 24 hours a day, seven days a week.
- Some of the issues that are addressed include bowel and bladder control, keeping your skin healthy, wound care, self-medication, intravenous therapy, and others.
- You may request private duty staff at your expense. Our staff is available to help make arrangements for these services if desired.
- The dietitian will discuss with you what foods you prefer and what foods are needed for your therapeutic diet plan.
- The dietitian will also teach you about any changes you may need to make in your diet at home.
- Physical therapists are available to work with you to overcome the weakness, immobility, and/or other physical impairments that are sometimes caused by illness, disability, or injury.
- The primary focus of physical therapy is to assist you to regain your former level of functioning through exercise, bed and wheelchair mobility, transfer training, and walking skills.
- Occupational therapists are available to assist you in attaining independence in activities of daily living which include feeding, bathing, dressing, hygiene, and homemaking.
- To help you achieve independence, adaptive equipment such as a wheelchair, shower chair, special feeding tools or utensils and splints may be recommended.
- The speech/language pathologist works with the staff and your family to develop strategies that will increase your ability to communicate and/or swallow.
- Speech pathologists also provide treatment for communication disorders and problems with reading, writing, attention, memory, and reasoning.
- Activities are an integral part of your care to help you improve functional abilities and maintain leisure activities to enhance your health and well being when you go home.
- An activity calendar will be posted in your room and in the Dining/Activity Room. You will be encouraged to participate in social and recreational events.
- The Continuity Care Planners provide support to you and your family in the areas of lifestyle transition, planning for future therapy, and for care after your stay in the Transitional Care Unit.
- Continuity Care Planners will help you to develop a comprehensive discharge plan and locate appropriate community resources to assist you with your return to the community.
- Transitional Care Unit beds will not be held if the resident is readmitted to the hospital or other therapeutic facility. The bed will be retained if the resident is out for observation, admission, ambulatory surgery, or a special exam/treatment.
- Serious or chronic illness often brings emotional and/or financial stress to you and your family, affecting your ability to function and recover and your family’s ability to cope.
- The social worker can provide supportive counseling to you and your family or arrange for psychological services to help improve your psychological and social well being.
- Pastoral counselors are available on the Transitional Care Unit for your spiritual welfare and comfort and can visit you.
- If you prefer, we will be happy to contact your rabbi, priest, or pastor.
- Clergy may visit at any time, day or night. Arrangements for a private visit can be coordinated with our staff.
- All services available to patients at Passavant Area Hospital are available to residents in the Transitional Care Unit.
- Special diagnostic procedures and studies are to be ordered by your physician.
- Emergency services, including the administration of life support, can be initiated at Passavant Area Hospital.
- Your medications are administered by the nursing staff on physician’s orders and are stored in the Nurse’s medication area.
- If you desire to administer your own medications while in the Transitional Care Unit, please discuss your wishes with the nursing staff.
- Your family may bring in special foods from home as long as they meet your special medical needs. Please discuss this with the nurse or dietitian.
- All foods brought into the Unit will need to be stored in airtight containers and marked with the resident’s name. A refrigerator is located on the unit for resident use.
- Meals will be served at approximately 7:30 a.m.; 11:30 a.m.; and 4:45 p.m., with an evening snack around 8:00 p.m., if desired.
- Since our focus is on rehabilitation and restoration, the environment here is more home-like. We will want you to wear your own clothes to assist in improving your overall well-being and prepare you for going home.
- Your family or friends should bring you:
- Two-three changes of comfortable street clothes
- Socks and shoes (or slippers with firm soles)
- Personal nightwear and robe
- You will need your family or friends to do your personal laundry.
- Hospital gowns will be provided by the facility, if needed.
- In addition to clothing, you will need toiletries and, if desired, personal items such as reading materials, photographs and stationery.
- If you wear glasses, dentures, hearing aids, or any prostheses, please bring them with a storage case with personal identification so they will not be lost or damaged when not in use.
- The Transitional Care Unit conducts fire drills periodically. Should this occur during your stay, please remain in your room and do not be concerned.
- Your bedroom door will be kept shut during the duration of the drill and reopened by facility staff.
- The Transitional Care Unit is a smoke-free facility. The non-smoking regulations apply to both residents and visitors.
- We ask that you leave valuables such as jewelry, credit cards, or large amounts of cash at home.
- If you do have items of value with you, please ask the staff about securing them for you during your stay.
- Visiting hours are unrestricted. Children of any age are welcome.
- To protect your health and the health of other residents, people with colds, sore throats, and other communicable diseases are asked not to visit until the condition has cleared.
RESIDENT RIGHTS AND RESPONSIBILITIES
- A copy of Resident’s Rights and Responsibilities will be given to you during the admission process.
- If you have been adjudicated incompetent in accordance with law, and are found by your physician to be medically incapable of understanding these responsibilities, or exhibit a communication barrier, your guardian, next-of-kin, or legally authorized responsible party assumes these responsibilities for you.
- A copy of TCU’s most recent survey results are posted in the dining room for your examination.
DIRECTIVES FOR MEDICAL CARE
- During the admission process, you will be given a booklet called, “Quality of Life Decisions”, and asked if you have an Advanced Directive, Living Will, or Durable Power of Attorney. This is routine for all admissions.
- This form gives our Transitional Care Unit staff direction in case of an emergency. Such an emergency is unexpected; however, since the length of stay is longer in TCU, we must be prepared for any event.
- The completion of this form assures us we will properly intervene in any situation.
PROCEDURES TO SOLVE PROBLEMS
The entire staff of the Transitional Care Unit is dedicated to providing the finest quality care available to make your stay as comfortable as possible. We welcome your comments and suggestions to better meet this goal. In the event that you are not satisfied with the care or any other aspect of your stay, we would like to suggest you contact the following members of our staff:
Primary Care Nurse
- The nurse assigned to your care will make every effort to correct problems you may have. Please address any concerns, problems, or complaints directly with this individual.
- If your primary care nurse has not resolved the problem to your satisfaction, please ask to see the Nurse Manager or call (217) 245-9541, extension 3100.
- If your concern has still not been addressed adequately, please ask to see the Clinical Director of the Transitional Care Unit or call (217) 245-9541, extension 3120.
- After following this procedure, if you still feel your problem has not been adequately addressed, you have the right to contact any of the following agencies and report your concern:
- Ombudsman Program, Long-term Care Ombudsman Program – (800) 842-8538
- Office for Civil Rights, Department of Health & Human Services – (217) 492-4373
- Department of Health, Illinois Department of Public Health – (217) 782-7412
- Financial arrangements should be made prior to your admission into the Transitional Care Unit.Should you have any difficulty in financing your stay, please contact our Clinical Director at the time of your admission.
- The Transitional Care Unit is approved by Medicare and other health insurers.
- Your insurance coverage is a contract between you and your insurance company.While we will cooperate to the fullest extent in expediting your claim, you are ultimately responsible for payment of your account in case of delay or denial of payment.
- If your skilled care coverage is terminated or falls outside a benefit period, you will be charged for full daily rates including: room and board, pharmacy, therapy, laboratory, and supplies. You and/or a family member will be informed in advance in order to plan an appropriate discharge.
- If you decide to remain on this unit after coverage has expired, please contact the Business Office to obtain financial information and make the appropriate arrangements.
- The insurance consultants provide assistance and information related to your admission to the Unit and answer your questions about financing your stay.
- Any questions regarding Medicare can be answered by Lorna Legreid, Medicare Consultant, by calling (217)245-9541, extension 5573.
- Any questions regarding private insurance can be answered by Marsha Walls, Utilization Review Nurse, by calling (217)245-9541, extension 5548.
- As long as you continue to qualify for skilled nursing and rehabilitative services, Medicare covers all medically necessary treatment, including room and board, up to a specified number of days:
- The first 20 days of your stay are covered at 100%, if medically necessary.
- The Medicare co-payment is $119.00/day for days 21-100.
- Pharmacy supplies, medication, therapy, and laboratory services are also covered.
- If you are admitted under Medicare, you are responsible for the co-insurance portion of the plan if there is no other policy to cover it.
- You may apply any additional insurance coverage to the co-insurance portion of your bill.
- Physician services rendered to Medicare patients are generally covered under Part B and are billed separately.
Medicare Supplemental Insurance Policies
- Some supplemental insurance policies pay all co-insurance costs during a Medicare qualified stay. Eligibility requirements vary by policy. Questions concerning your supplemental insurance policy should be directed to your insurance agent.
- The Medicare Consultant will verify any supplemental coverage, provided all insurance information is submitted prior to admission.
- Discharges are scheduled daily at your convenience.
- Our entire staff is available to you and your family members to help ease your transition after discharge.
- The Transitional Care Unit continuity care planner can connect you with a comprehensive range of personal, family, and community resources upon discharge. A list can be obtained by calling the continuity care planner at (217)245-9541, extension 3420.
- The Interdisciplinary Team and physician will use professional judgment to determine when you do not require skilled nursing or rehabilitation and can be discharged.
- If you request to be discharged against the physician’s advice, the unit will not be held liable for any injuries, harm, or complications resulting from your discharge.
- Please tell the person who is taking you home to notify the nursing staff when she or he arrives.
- For your safety and convenience, a staff member will take you by wheelchair to the hospital entrance to meet your ride.
- If you have no way of getting home, our staff will help you find transportation. Please notify your nurse or continuity care planner as soon as possible so these arrangements can be made.TRANSITIONAL CARE UNIT PHONE NUMBERS
|Nurse Manager/Clinical Director
|(217) 245-9541, ext. 3120
|(217) 245-9541, ext. 5690
|(217) 245-9541, ext. 3910
|(217) 245-9541, ext.5573
|Transitional Care Unit
|(217) 245-9541, ext. 3100
|Passavant Area Hospital