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Part of the complete continuum of care

Acute care coordinators provide peace of mind, seamless transitions

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August 9th, 2016
Ann’s Choice acute care team members (from left) Jennifer Steinhauer, Ed McDermott, Karen Meyers, Connie Fennell, Emilia Xavier, Suzanne Tepper, Pete Cataldi, Lindsay Schwartz, Beth Branchide, Wanda Herman, and Alexandra Solarz.

Ann’s Choice acute care team members (from left) Jennifer Steinhauer, Ed McDermott, Karen Meyers, Connie Fennell, Emilia Xavier, Suzanne Tepper, Pete Cataldi, Lindsay Schwartz, Beth Branchide, Wanda Herman, and Alexandra Solarz.

Planned or unplanned, hospital stays are stressful. 

So Ann’s Choice, Erickson Living’s retirement community in Bucks County, Pa., has established a team to help alleviate community members’ concerns while they’re in the hospital and to make their transition back to independent living as seamless as possible.

As a continuing care community, Ann’s Choice provides a complete continuum of care right on its grounds. Its acute care coordination program provides peace of mind and another dimension to that care. 

Project manager for your health

Connie Fennell, R.N., is Ann’s Choice’s acute care coordinator. Her services are available at no charge to everyone who lives at Ann’s Choice.

When a community member in independent living has been hospitalized, Fennell contacts the hospital’s case manager and social workers to let them know she’ll be following the patient’s care from admission through the transition back home.

Fennell spends the majority of her time visiting local hospitals. Typically, residents go to Abington Hospital—Jefferson Health, but not always.

During those visits, she talks with patients and family members, and confers with hospital staff to stay abreast of the patient’s situation. She also informs patients about their health care insurance and coverage.

She relays daily confidential updates to Ann’s Choice’s medical center and the person’s family members—only those people who are directly involved in an individual’s care.

Whether the community member has been hospitalized for a planned knee replacement or a medical emergency, Fennell follows the same procedure. She even monitors the care of those who are hospitalized out of state.  

Charting a smooth transition home

Besides monitoring hospital stays, Fennell plans their smooth return back to independent living, to rehabilitation, or for additional care at Rose Gardens, the on-site rehabilitation and continuing care neighborhood at Ann’s Choice.

“I know getting home is important,” she says, “so I coordinate whatever they need, even if it’s as simple as only providing a ride.”

She emails the Ann’s Choice security department, medical center, and social workers about each resident’s destination. Regardless of where someone goes following discharge, a social worker will reach out to them.

Fennell also coordinates with Ann’s Choice’s home support program if returning community members need those services. “Home support is a big part of our in-home care services,” Fennell says. 

She also arranges for the pharmacy to deliver any prescribed medications and talks with the hospital’s floor nurse to ensure that a last dose of medication is given before discharge.  

The value-added benefit, peace of mind

For community members and their family members who’ve taken advantage of the Ann’s Choice acute care coordination program, Fennell’s services have made a lasting impact.

A resident for whom Fennell coordinated a transition from the hospital to Rose Gardens for inpatient rehabilitation approached her at a campus event to show Fennell how well she was doing. Now back in independent living, the woman says that Fennell was key to getting her the care she needed. 

Another resident’s family member, a man who lives at some distance from Ann’s Choice, also values Fennell’s services. He told her he has peace of mind not only because his mother lives at Ann’s Choice but also because of the acute care coordination program. He knows he can rely on Fennell to ensure his mother is well taken care of.

“You coordinate whatever Mom needs on discharge,” he told her. “Whether it’s medications or extra support, you make the contacts for me. And you arrange for the ride to bring Mom home in a timely way.” 

“This is a wonderful, wonderful value-added service for people who live at Ann’s Choice,” Fennell says. “Erickson Living has thought of everything in terms of providing people with the best possible care.”

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