INNOVATION

The Encore Integrated Memory Care program is a powerful resource for hospital partners facing the challenge of patients with dementia who exhibit challenging symptoms or disturbances. The Encore program provides compassionate and effective care for these patients, focusing on maximizing and preserving cognitive function while managing symptoms and behaviors.

The Encore Difference: CDP Training & Certification

All staff members on the Encore Unit – including caregivers, therapists and even recreation staff – receive extensive education, training, and orientation, earning certification as Certified Dementia Practitioners. Staff members are equipped with the knowledge and skills they need including:

• Communication strategies to deal with cognitively impaired patients.
• Responsive techniques to manage unexpected behaviors.
• Effective reactions to patients’ unmet and unspoken needs.
• Strategies to support advanced stage patients prone to physical/verbal disturbance.
• Devising patient-specific activities program and care plans
• Monitor and detect signs of disease progression.

Ensuring discharged patients take the right dosage of the right medicine at the right time is challenging but crucial. Incorrect medication administration is one of the leading causes of post-discharge health complications, often leading to readmission.
MedAhead was developed to ensure a smooth and safe transition to the post-discharge environment. The central component is a Personalized Daily Medication Kit, prepared under the guidance of patient’s caregivers in collaboration with our pharmacy partner. The kit features an easy-to-use tear-off blister-pack ‘Bingo-card’ design with clearly identified dosages and instructions, avoiding confusion and promoting medication compliance. The innovative kit makes accurate medication a simple and stress-free experience.
Other program features include:

• Pre-discharge patient orientation – A thorough review of all prescription and over-the-counter medications prior to discharge, to avoid duplicates as well as negative drug interaction.
• Free home delivery  – Upon discharge, pharmacy will deliver medications organized in easy-to-use bingo-card blister pack to patient’s home in a convenient box, ideal for carry-along to physician appointments.
• Refill delivery – At refill time, the new supply of bingo-card medications in a box will be delivered to patient’s home.
• Free medication review – Upon discharge and at each refill interval as needed, a pharmacist will visit patient’s home for medication reconciliation, reviewing all medications and discarding any that are duplicate or expired.

The Center for Pulmonary Excellence, currently available at Hampton Ridge Healthcare and Rehabilitation, offers a new level of advanced pulmonary care in a post-acute setting.

The Center was developed in conjunction with top pulmonologists and nurses to provide patients with a high level of care and management for a broad range of pulmonary conditions, such as COPD (Chronic Obstructive Pulmonary Disease), pneumonia, and post-tracheotomy, among others.

The Center for Pulmonary Excellence features a stellar clinical team of experienced caregivers trained in the treatment and protocols specific to this patient population. The Center also features state-of-the-art specialized equipment, advanced clinical capabilities, and a comprehensive patient education/training program that is highly effective in preventing relapses and hospital readmissions.

The Center for Pulmonary Excellence is affiliated with area hospitals, and plays a pivotal role in the continuum of care, supporting patient needs and improving clinical outcomes

Clinical Capabilities

The Center for Pulmonary Excellence provides the full scope of post-acute care services as well as comprehensive pulmonary-specific services with advanced clinical capabilities. Significant among these is the administration of piped-in oxygen with a capacity of 15 liters per minute, enabling clinicians to deliver 100% oxygen to patients as needed. The Center’s care program addresses a wide range of pulmonary needs, with treatment that includes:

Curavi Health^TM is a revolutionary tele-medicine system that brings physicians to a patient’s bedside – virtually. Curavi Health^TM uses video technology and digital diagnostic tools to render a pinpoint virtual diagnosis.

The patient is “examined” by qualified Board-certified physician who determines a course of treatment. The entire process is done in close collaboration with the attending nursing staff as well as the patient’s regular physician, resulting in seamless care without the trauma and discomfort of an unnecessary ER visit.

Since Ocean Healthcare Network facilities accept admissions 24/7, they maintain a common Readmission Hotline providing trained Patient Care Coordinators standing by to accept qualifying admissions24/7. The service, known as DirectLine, is the only one of its kind marketed directly to Emergency Room personnel as a valuable resource. DirectLine enables ER staff to avoid readmissions by directing clinically appropriate patients to be treated in one of Ocean Healthcare’s post-acute facilities.

In addition to processing admissions around the clock, Ocean Healthcare Network members also accept patient referrals 24/7. This facilitates patients’ expedited discharge from hospitals and reduces the overall costs of healthcare reimbursement.

This signature Ocean Healthcare Network program has made a significant impact in readmission reduction and improved clinical outcomes.

To ensure that patients discharged from a Skilled Nursing facility are receiving proper care, Ocean Healthcare Network members collaborate to provide care options such as Home Health Care, Home-Based skilled Nursing, Adult Day Health Services, Assisted Living Communities, and Hospice Care. The providing caregivers work in tandem with the discharging facility to thoroughly understand the patient’s history and meet their specific care needs.

The Transitional Care Coordination Program effectively bridges the care gaps that commonly lead to the incidence of unnecessary hospital readmission, namely: medication complications, insufficient home health care, inadequate durable medical equipment, and lack of follow-up physician/medical care.

Patients are provided with clear instruction and guidance at the time of discharge. A designated Care Coordinator provides extensive follow-up after the patient is at home to ensure that the patient’s medications, home environment/care, equipment, and medical oversight are thoroughly addressed.