Post Discharge Care

Community Integration

Integrated health care is a relatively new strategy that has gathered plenty of praise for its efficiency and cost effectiveness. Not only are patients receiving better care, the communities that employ such strategies are seeing positive results as well. We are your eyes and ears in the community and have access to providers who help those needing supportive care and housing communities that are affordable.  

How We Help Families

We identify your level of care needs and preferences, including location, community preferences and budget. Our assessment covers all functional areas from medical needs to personal care and hygiene needs. We also pre-screen all recommended provider for deficiencies, star rating, and penalties 

Types of Housing Options

Whether needing independent living, family care home, or an assisted living community; we recommend housing options for seniors that provide supportive services to include activities of daily and independent activities of daily living.  

Requirements for Services

All healthcare workers please fax to our office completed FL2  and H&P along with payee type and budget. For more information contact Ursula at 919.869.4215. 

Requirements Upon Discharge

All applicant for supportive housing options upon discharge must provide:

  • Current signed and completed FL2  with medication/treatment on FL2 not on a separate page
  • Two step TB sking test
  • H&P
  • 30 dady supply of all medication to allow for adjustment of mail order system

If diabetic and getting blood sugar checks; a 30 day supply of test strips/lancets and a glucometer needs to be included.