Transitional Care in Lake Oswego

Why transitional care?

After an illness, injury or hospitalization, many patients are weaker than when they entered the hospital. So a short stay in a transitional care unit may be needed to work on regaining strength, nutrition and medication management before returning home.

How long will you be here?

Every patient situation is different. Our planning process for your recovery begins the moment we get the call from the hospital. In the first hours of your arrival, our nurse and therapists will work with you to assess your current needs and set goals for your recovery. For some patients reaching their goals may take a few weeks for others more time may be needed. The length of your stay will depend on reaching your functional goals and minimizing complications. You are an active partner in both. The key to determining when you are ready to be discharged is an agreement by your care team members that there is little chance of new complications arising that might send you back to the hospital. 

How will I track my progress?

Routinely, your care manager will meet with you to track your progress.  You’ll review your areas of accomplishment and discuss next steps for meeting your functional goals.  This  “mini-meeting” will help you help us adjust the plan as we progress into the next phase of your recovery.

Going home

When goals are met, strength and independence have returned, we help you plan for the next step in your recovery—going home. Some will consider other options; Independent Living, Assisted Living, Home Health, Home Care and if necessary, Hospice Services. We can assist in arranging the services that best meet your needs.