Hospital Avoidance Programs for:

• Heart Failure

• COPD

• Diabetes

• Medication Reconciliation 

 

TeleHealth: 

• Daily heart rate, B/P, weight, O2 readings for at risk cardio/pulmonary patients

• Customized physician reports

• In-home wireless system to monitor vital signs and symptoms

• Securely transmit data to the health care team including the physician

• Trends identification and preventive care 

• Includes cardiac and pulmonary conditions not limited to Heart Failure and COPD.

Certified Wound Care Team:

• Vacuum Assisted Wound Closure

• UNNA Boot application

 

IV Therapy

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Palliative Care:

• ​Symptom control

• Pain management 

• Patient and family education

• Assist with transfer to other levels of care as indicated

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Care Transition Services:

• Seamless transition to home care

• Face to Face instruction for physicians and/or staff 

• Assistance with 485’s and orders as needed

• Resource for community outreach and service

• Clinical Liaison Services: Transition clients and caregivers through the health care continuum

• Pre Surgical Screening:  Assess client needs pre-operatively for optimum post-operative results

• Social Worker Services: Assist clients and caregivers with long term care planning and social issues

• Hospice & Palliative Care: Seamless transitions to partner agencies with Hospice services

• Our intake nurses take direct referrals from physician offices to prevent patient hospitalizations 

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Care Path Services:​​

• Heart Failure

• COPD

• Diabetes

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Public Health Nursing Services:

• Norfolk, Dover, Medfield, and Sherborn

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