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Returning Home After a Hospitalization and Need Support

After a hospitalization, maintaining self-accountability for your health and wellness goals involves understanding your diagnosis and treatment plan, carefully following doctor’s orders and receiving the right level of support. Home health care professionals are here to empower you in every way, improving outcomes and enhancing quality of life.

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Our case manager was extremely helpful in explaining the benefits, schedules, and costs, and she was able to get us started very quickly. The care givers were very friendly and kind to my mother-in-law. I will recommend them to others.

Loraine D. November 22, 2022

I have had my physical therapist in my home for awhile now due to my back issues. She is kind and very knowledgeable, she has helped me so much. I have a long way to go to be able to walk with a cane, but with her help, I’m sure it will happen.

Elizabeth F. Orange County Nov 7, 2022
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Discovering the Right Support for My Recovery

A complex medical event is often intimidating. It’s easy to focus solely on your hospital stay without giving too much thought to what happens after you’re discharged home. Yet, the way support is offered once you return home is critical for your safety and wellbeing, and it decreases your chances of being readmitted to the hospital. Patients and family caregivers play an important role in this process, but you may feel unprepared to fully manage the recovery period ahead on your own.

Patients who prefer the comforts and conveniences of familiar surroundings can safely recover at home with professional home health support. Salus Home Health case managers work with you, your family caregivers, nurses, therapists and your primary doctor to provide a seamless transition home by establishing a restorative plan of care that addresses complex medical needs and helps you regain your previous level of functioning. This results in superior outcomes while lessening the burdens place on your loved ones and improving your overall quality of life.  

How Salus Integrated Services Can Help You Overcome a Serious Medical Illness

Home Care

Illnesses and the aging process can impact your ability to live independently at home. With the right support, safety and comfort are prioritized, goals are easier to meet and your quality of life improves too.

What are the typical goals of care for this type of service?
To remain safe and comfortable in your own home or place of choice in times of recuperation or during the normal aging process
Why choose this type of care?
Maintain dignity and independence allowing you to age safely in the comfort of home. May also be helpful to assist with care needs following surgery or hospitalization.
What kind of services are available?
Assistance with activities of daily living can include bathing, grooming, meal preparation, and medication reminders. Also light housekeeping and other requested services.
Who pays for this service?
Private pay; for those that have long term care insurance their policy may pay a good portion of the costs; for those qualifying war-time veterans (or spouse) the VA covers a small portion.
How often does the care happen?
As often as you would like. Can be hourly for brief periods (min of 4 hrs) or up to 24hrs/day 7 days/wk
Who is involved in the delivery of care?
A case manager and a caregiver.
Who determines what care is delivered?
The case manager and family make this decision together
Is a physician order required?
No
Is anything else required?
An in-home assessment performed by the case manager to determine the plan of care.
If equipment is needed (i.e. hospital bed, walker) who pays for that?
The majority of the time this will be the responsibility of the patient/family
How do I get started?
Give Salus a call. We will schedule a case manager to visit at no cost.
How long does the service last?
As long as needed and desired by the client
Why choose Salus?
Salus offers the patient and family with the most expert and nurturing care during all phases of a patient's healthcare journey. At Salus we are "Always There" and provide the patient and family with choices across the continuum of care.
(888) 725-8742

Home Health

Returning home from the hospital and reducing the risk of setbacks associated with a chronic health condition is easier with the right support. Home health care helps you to reach optimal recovery goals.

What are the typical goals of care for this type of service?
To regain prior level of function/health. Promote the patient's ability to move, reduce pain, restore function and prevent disability.
Why choose this type of care?
To regain health and to resume the previous level of function and independence.
What kind of services are available?
Multidisciplinary team approach. Patient's physician arranges Medical Equipment and Medications; must be authorized by insurance.
Who pays for this service?
Medicare, Medicaid, Commercial Insurance or by the patient directly; May have co-pays according to plan.
How often does the care happen?
Care is determined by the doctor but is typically comprised of intermittent visits by nursing and therapy over the course of 30-60 days according to an individualized plan
Who is involved in the delivery of care?
Home Health services are ordered by a physician and can include nursing, physical, occupational or speech therapy, medical social services, home health aide and registered dietician
Who determines what care is delivered?
The patients ordering physician determines the disciplines necessary to meet the patients' needs
Is a physician order required?
Yes
Is anything else required?
Patient must meet home-bound requirements
If equipment is needed (i.e. hospital bed, walker) who pays for that?
Depends on eligibility
How do I get started?
Discuss desire for care with your physician; Give Salus a call
How long does the service last?
As long as the patient has the potential for improvement with restorative treatment. Must meet insurance eligibility guidelines.
Why choose Salus?
Salus offers the patient and family with the most expert and nurturing care during all phases of a patient's healthcare journey. At Salus we are "Always There" and provide the patient and family with choices across the continuum of care.
(888) 725-8742

Hospice

After receiving a terminal diagnosis, living with dignity is what matters most. Hospice care provides emotional, spiritual and physical support to reduce pain and discomfort so you can enjoy each day more.

What are the typical goals of care for this type of service?
Affirms life and regards dying as a normal process. Comfort and symptom management; Maintain comfort and quality of life during the end stages of a serious illness to which the doctor does not expect a cure; care for physical, psychosocial and spiritual needs. Reduces suffering. Improve the quality of life for both the patient and family.
Why choose this type of care?
To stay in the comfort of your own home, avoid hospitalization, during your final months, weeks and days of life. To forego curative treatments, rather focus your remaining time left on things that matter most. There is no homebound requirement.
What kind of services are available?
An interdisciplinary team provides holistic care. Includes coverage for medications related to management of the end stage disease, Medical Equipment and Nursing Supplies (i.e Incontinence, Gloves, Woundcare dressings).
What kind of services are available?
Medicare (Part A) and Medicaid 100% covered; Most private insurances also have coverage, including VA benefit
How often does the care happen?
Hospice support is available 24/7 although the frequency of intermittent visits can vary based on the patients individual care needs and can change as the patients' needs change
Who is involved in the delivery of care?Hospice has an Interdisciplinary approach to care, the hospice team includes a doctor, nurse, social worker, spiritual care coordinator, home health aide, and volunteers
Hospice has an Interdisciplinary approach to care, the hospice team includes a doctor, nurse, social worker, spiritual care coordinator, home health aide, and volunteers
Who determines what care is delivered?
The hospice team works together with each patient and their family/caregivers to determine the services they would like to receive while under Hospice care. Collaborates with the physician for updates and orders.
Is a physician order required?
Yes
Is anything else required?
Patient must have a terminal prognosis of 6 months or less certified by two physicians
If equipment is needed (i.e. hospital bed, walker) who pays for that?
Included in benefit
Included in benefit
Discuss desire for care with your physician; Give Salus a call
Discuss desire for care with your physician; Give Salus a call
Designed for patients during the last 6 months of life if the disease runs it's usual course. Should the patient's condition improve, the hospice team will assist with discharge planning from hospice to other healthcare options.
How do I get started?
Salus offers the patient and family with the most expert and nurturing care during all phases of a patient's healthcare journey. At Salus we are "Always There" and provide the patient and family with choices across the continuum of care.
(888) 725-8742

Palliative Care

Many challenges come along with being diagnosed with a serious medical conditions. Your ability to overcome them impacts your health, happiness and quality of life. Your medical team can help you overcome many of these challenges, but when their support alone isn’t enough to manage symptoms, discomfort and stress, Salus Palliative Care is here for you. Our team of doctors, nurses and trained professionals provide personalized support to empower you to live each day to the fullest and get the most out of any curative treatments

What are the typical goals of care for this type of service?
Affirms life and regards dying as a normal process. Comfort and symptom management; Maintain comfort and quality of life during the end stages of a serious illness to which the doctor does not expect a cure; care for physical, psychosocial and spiritual needs. Reduces suffering. Improve the quality of life for both the patient and family.
Why choose this type of care?
May receive curative treatments between the home and hospital during the last months, weeks and days of life. Medicare requires the patient must be homebound.
What kind of services are available?
Interdisciplinary team provides holistic care. Patient's physician arranges Medical Equipment and Medications; must be authorized by insurance.
Who pays for this service?
Medicare (Part A) and Medicaid with no co-pay;Most private insurances also have coverage. May have co-pays according to plan.
How often does the care happen?
Intermittent visits by the Palliative Care Team according to an individualized plan.
Who is involved in the delivery of care?
Palliative care is ordered by the patients physician and may include a RN or Nurse Practitioner, medical social services and a consultation with spiritual care.
Who determines what care is delivered?
Palliative Care Team, led by a Nurse Practitioner, confers with the patient's physician in developing a unique plan to meet the needs of the patient and family. Includes Advanced Care Planning discussion on end of life goals.
Is a physician order required?
Yes
Is anything else required?
Patient must meet home-bound requirements.
If equipment is needed (i.e. hospital bed, walker) who pays for that?
Depends on eligibility
How do I get started?
Discuss desire for care with your physician; Give Salus a call
How long does the service last?
As long as patient meets eligibility guidelines for palliative care. As condition declines, many patients choose Salus Hospice to best meet their holistic needs, including experienced end of life care staff.
Why choose Salus?
Salus offers the patient and family with the most expert and nurturing care during all phases of a patient's healthcare journey. At Salus we are "Always There" and provide the patient and family with choices across the continuum of care.
(888) 725-8742

Frequently Asked Questions

If you don’t see your question, please give us a call: (888) 725-8742

Discharge planning is the process of preparing you to move smoothly from one level of care to the next. Your doctor will prepare the order for release from the hospital, and then a hospital medical social worker will provide support in determining what your care needs and equipment needs are in order to safely transition to home. When at home services are needed, a care manager from Salus will visit with you in the hospital, prior to discharge, and work with you to develop a plan of care that outlines goals, challenges and services. We’ll discuss scheduling, help to coordinate with Medicare or your insurance company and provide clear communication with your primary doctor to set you up for success as you transition home. Effective discharge planning makes it safer for you to comfortably return home. It also ensures that your family caregivers are supported and never burdened with tasks that they are ill-equipped to manage alone. Establishing the right in home services is a key component in your discharge plan. This step reduces opportunities for hospital readmissions or missteps in administering medications and makes the recovery process less stressful and more productive. Yes, the decision about which home health provider to use is yours to make. Your hospital discharge planner may make recommendations about certain companies, however, if you have a preference, simply indicate that when discussing your discharge plan. You may also contact Salus Homecare directly, and we will coordinate with the hospital social worker throughout this important step. Any services that are considered medically necessary by your primary physician are typically covered by Medicare, MediCal, Medicaid or private insurance. Our case managers can help you in contacting your payment provider and coordinating payment for care. Home health is typically a short-term service, provided on a part-time or intermittent basis and remaining in place through a portion of your recovery at home. Your doctor will monitor your recovery and, in coordination with you and your home health nurse, determine when it is appropriate to reduce or terminate services. Home health services are skilled services provided by a licensed medical professional. Typically, they do not include more extensive personal care, meal preparation or other non-skilled services. In cases where patients need this type of assistance post-discharge, Salus’ integrated model of care can provide both home health and home care support.

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Download Our Guide

This free guide shares more about our professional, integrated in home services.

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Call Our 24/7 Hotline: (888) 725-8742

Call Our 24/7 Hotline: (888) 725-8742

Call Our 24/7 Hotline: (888) 725-8742

Call Our 24/7 Hotline: (888) 725-8742
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