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Chronic Disease Management Program from Home | Foster Healthcare

Chronic Disease Management from Home

Living with a chronic disease can be challenging, but patients who take an active role in their own care can make more informed choices and are less likely to be rehospitalized down the road. Our Chronic Disease Management programs focus on involving patients in the health care process so they can achieve more independence and a better quality of life. The goal of each of our programs is to decrease hospitalizations for the long term. We use the most current medical evidence to develop our clinical and patient education, and plans for patient care. Our approach to patient care starts with disease management education. We teach our patients the tools they need to self-manage and identify red flags that may cause their condition or symptoms to worsen – promoting early intervention and greater independence.

Heart Care from Home
All heart conditions, no matter how complex, are managed under the Heart Care from Home program.  Foster clinicians provide detailed assessment and education to help patients successfully manage medication, symptoms, mobility and other aspects of care. If needed, they will coordinate other services, including physical therapy, special equipment and nutritional education. Our goal is to provide the information and skills needed to stay safely in the home after home health care has ended.

Wound Care Healing from Home
Wound care is frequently complicated by other conditions that make care more challenging. Foster implements the most current evidence-based practices, incorporates the latest techniques, and uses the most advanced products to improve healing and ultimately enhance the patient’s and family’s quality of life. Forming a partnership with the patient, caregiver, personal physician, physical therapist, WOCN/ET certified nurses and home health aides enables Foster to address every aspect of wound care.

Diabetes Management from Home
Patients with Type 1 and Type II diabetes have different needs for education and medical supervision. Fosters’ skilled clinicians are prepared to provide customized support for each of these conditions based on the individual patient’s needs. The education Foster provides is valuable whether the diabetes is newly diagnosed or longstanding, as information for the successful management of diabetes has expanded greatly in recent years and treatment is better than ever before. The Foster clinician focuses on each patient’s specific needs, improving quality of life and enabling patients to achieve their best health status.

Stroke, COPD, CHF, CVA Rehab from Home Helping patients regain independence is our ultimate goal. In our Rehab from Home program, an individualized plan is developed for each patient after a clinical evaluation. Our clinicians coordinate services for the management of acute and chronic diseases including congestive heart failure, chronic obstructive pulmonary disease, diabetes and cerebral vascular accident. Our clinical team uses therapeutic skills to assist the patient in improving strength, mobility, balance, swallowing and communication disorders.

Orthopedic Recovery from Home

A combination of skilled nursing care and therapeutic rehabilitation in the home creates an excellent environment for recovery after an orthopedic surgery or injury. Skilled in the care of joint replacements, orthopedic injuries and complex orthopedic disease patients, our clinicians provide the skilled nursing and licensed therapeutic care to support patient recovery based on established clinical protocols. Our goal is to assist the patient in reaching the highest possible level of independence in the comfort of their home.

Behavioral Health from Home and Empowered for Life

Patients with psychiatric conditions have special needs. Frequently, psychiatric illness exists in tandem with physical illness, requiring nursing care that is specific to both conditions Foster psychiatric nurses are trained to provide care for the total patient, including chronic disease conditions and education for the patient and caregiver. Working with the psychiatrist and/or primary care physician, our clinicians make sure the needs of the patient are being managed effectively. Our Empowered for Life program also provides services to younger psychiatric patients who are placed on disability due to the severity of their mental illness. Consistent home care, provided by our credentialed psychiatric nurses, reduces inpatient readmissions and teaches the patient and caregiver to better manage the illness in the home. At the request of Veterans Administration hospitals, some geographic regions serve war veterans as they return from Iraq and Afghanistan.

COPD Management from Home
Living with Chronic Obstructive Pulmonary Disease (COPD) is stressful for patients and their families. Our skilled clinicians provide care, therapies and education that improve their ability to manage COPD and enjoy an improved quality of life. Patients and caregivers are encouraged to actively participate in creating the management plan and trained in the skills needed to comply with the plan. Adhering to a structured care plan will help prevent or delay complications and achieve the best possible outcome.

Chronic Kidney Disease Management from Home
Patients and families coping with Chronic Kidney Disease have the support of Foster clinicians who provide ongoing assessment, timely treatment and coordination with physicians, renal clinics and other health care providers. Our skilled clinicians provide information and education to support the patient and family, improve the patient’s quality of life and decrease the overall stress level that this condition creates. With reliable information about the disease and its management, patients with Chronic Kidney Disease can control their condition and minimize its impact.

Pain Management from Home
Chronic pain significantly impacts quality of life for patients and their families. Our pain management program is designed as a team approach, actively involving patients, caregivers, skilled nursing professionals and other therapeutic disciplines as needed. Together, we develop a holistic treatment plan based on each patient’s individual condition. Using the best clinical evidence currently available, Foster clinicians work with the patient and family, teaching the skills needed to help them continue to control pain after the home health care has ended.

Balanced for Safety from Home
Falls are the leading cause of nonfatal, unintentional injuries treated in a hospital ER department–and the leading reason for admission to a skilled nursing facility. In the U.S. alone, one of three adults over the age of 65 falls each year, and more than half fall more than once. This annual rate increases to one of two over the age of 80. Fosters’ Balanced for Safety from Home is a comprehensive geriatric program that evaluates each patient to develop a systematic approach to treatment. The goal is restoration and management of the balance disorder to facilitate safe, independent living within the home.