Transitional Care Services
Life can be unpredictable, especially when a loved one has been in the hospital. For seniors, the transition from hospital to home can be particularly overwhelming, with a risk of complications or even readmission. At Visiting Angels, we understand these challenges and are here to make this transition smoother and safer for your family. Our in-home transitional care provides support following an in-patient hospital stay to help with recovery and decrease the risk of readmission.
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What is Transitional Care?
Transitional care supports seniors as they move from one care setting—like a hospital (such as North Memorial, Mercy Hospital or another hospital in the Twin Cities) or one of our local rehabilitation facilities (ex: Interlude Restorative Suites, The Villas at Osseo, Lake Minnetonka Shores, and others) —back home. It’s designed to reduce the risk of hospital readmissions, enhance recovery, and ensure peace of mind for both seniors and their families.
Did you know that nearly one in five Medicare patients discharged from the hospital are readmitted within 30 days? These readmissions often stem from incomplete discharge plans, medication mismanagement, or lack of proper follow-up care
Our intake team at Visiting Angels is able to meet with you and your loved one while they are in the hospital or TCU to discuss the discharge plan, talk about expectations and individual needs. The consultation can be done with family, care recipient, and medical team (if necessary). This meeting along with the discharge instructions will provide the information needed to create a care plan for our caregivers to follow once your loved one is back home.
Common Causes of Readmission
Seniors run a high risk of readmission during the first 30 days after discharge. In some cases, readmission is due to the inability to follow the doctor's discharge instructions. If they don't have support available at home they are at high risk to end up back in the hospital. Transitional care from Visiting Angels will provide the support and assistance your loved one needs to recover safely and comfortably in their home.
Most common causes of hospital readmission include:
- Taking medications incorrectly or missing doses
- General inability to follow discharge instructions
- Missing therapy or follow-up appointments
- Difficulty managing a new diagnosis at home
- Failure to follow a doctor prescribed meal plan
- Falls due to limited mobility or medication effects
How In Home Care Services Can Help
- Transition from Hospital to Home
Our team will work with your loved one’s healthcare professionals at the hospital or TCU to fully understand discharge instructions. We can provide assistance with medication management, medication management, personal care tasks and light household duties so you can focus on your loved one and their recovery. - Personalized In-Home Support
Post-hospital recovery can take a lot of time and energy. Our caregivers can help with personal care tasks like bathing, dressing, toileting, etc. as well as housekeeping tasks and meal preparation, so your loved one can focus on healing. - Companionship
Your loved one’s emotional health is just as important as their physical health. Loneliness can easily set in after spending time in a busy hospital or TCU where someone was always around. Our caregivers are present to provide that companionship and encourage activity and conversation to help lift spirits and reduce stress. - Fall Prevention Plans
Fall prevention is one of the biggest factors in avoiding hospital readmission. Seniors who experience falls are at a much higher risk of complications during their recovery. Visiting Angels caregivers are trained to identify potential fall hazards and provide mobility assistance to reduce the risk of a fall or accident. Another great resource is our fall prevention guide to help ensure a safe home environment.
Why Choose Visiting Angels for Transitional Care?
At Visiting Angels Wayzata, we provide the specific care your loved one needs. Our Transitional Care, "Ready, Set, Go Home," program starts at the hospital and continues with in-home support. With offices in Wayzata, St. Louis Park and Chaska, our team is happy to serve a wide community throughout the Twin Cities metro area. Our Wayzata office serves the cities of Maple Grove, Minnetonka, Delano, Plymouth, Orono, and other surrounding communities in Hennepin and Wright County.
We are also proud to be part of the larger senior care network throughout Minneapolis-St Paul that collaborates with organizations like the Alzheimer’s Association, Leading Age, and Community Partners in Parkinson’s Care. We continue to stay up-to-date on best practices from expert resources such as Teepa Snow’s Positive Approach to Care and The Virtual Dementia Tour.
Taking the First Step
Transitional care is more than just providing assistance at home—it's a commitment to health, safety, and dignity for your loved one as they recover after a stay in the hospital. Whether your loved one needs short-term support or ongoing care, we’re here for you, every step of the way.
To learn more about transitional care call us at 952-935-0789 or visit our office in Wayzata, MN. Also, check out our discharge guide for answers to common questions and ways we can help. Let us help your loved one thrive at home, confidently and comfortably.
Serving Minneapolis and the West and Southwest Communities
Visiting Angels WAYZATA, MN
901 Twelve Oaks Center Drive #908CWayzata, MN 55391
Phone: 952-935-0789