Patients and Their Families Professional Services

OnPointe At Home’s program is unique, because unlike many other home health care agencies, we’re able to provide these professional services with a team that includes a transitions coach and a nurse practitioner who work together and support each patient in developing four self-care management skills.
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PATIENTS & THEIR FAMILIES

The Professional Services provided by OnPointe At Home are part of the Medicare program called Transitional Care Management, a program created in 2013 to help patients manage their healthcare needs following a discharge from an Inpatient Acute Care Hospital, Skilled Nursing Facility, Long Term Care Hospital, Inpatient Rehabilitation Facility or Hospital, outpatient observation or partial hospitalization.

OnPointe At Home’s program is unique, because unlike many other home health care agencies, we’re able to provide these professional services with a team that includes a transitions coach and a nurse practitioner who work together and support each patient in developing four self-care management skills. Over a period of 30 days, they work closely with the patient to help them gain these skills and the independence needed to continue living at home with a better quality of life. Those skills include:

  1. Medication management
  2. Scheduling and preparing for follow-up care
  3. Recognizing and responding to red flags that could indicate a worsening condition
  4. Taking ownership of a core set of personal health information

Part of the continuum of care that OnPointe At Home takes pride in, the Transitional Care Management method shows that no matter what a patient's home health care needs might be, we are equipped to provide skilled, professional services in an empowering environment.

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Our hospice team includes your personal physician, the hospice medical director, nurse, home health aides, social workers, counselors and compassionate, trained volunteers who work together to provide the specific needs of each individual patient.

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Palliative Care is specialized medical care for people suffering from a serious illness. Its goal is to provide relief from the extreme symptoms and stress of an illness to improve quality of life for both the patient and his or her family and loved ones.

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Home health care services provided by OnPointe At Home are ordered by your physician and provided by our team of skilled nursing professionals, therapists and/or trained attendants. Because we have over 100 years of experience across many levels of healthcare, we can provide the best quality care for each individual patient, no matter what those specific needs might be.

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OnPointe At Home is part of a network of caring professionals all working together towards one common goal—providing comprehensive and exceptional services to our patients. As part of that comprehensive network, providing excellent personal care is our priority, so we’ve built a team to better deliver that level of quality.

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