At Tuscany Village Skilled Nursing & Rehabilitation, we take a proactive approach to reduce re-hospitalizations through comprehensive education and training for our nursing staff. Quality is at the forefront of our care philosophy, recognizing that proper patient care not only leads to improved outcomes but also reduces readmission rates and achieves cost savings. Our commitment to early care management and discharge planning ensures seamless communication across the care team, involving family members, primary care providers, and facility staff. Medication reviews are conducted face to face, providing patients with clear instructions on proper usage. We implement teach-back techniques to ensure effective patient education at a personalized level. Utilizing health information technology facilitates a smooth transition from inpatient to outpatient care.
Our enhanced training program for staff in assisted living and skilled nursing facilities focuses on identifying and addressing early changes in residents’ health. The presence of on-site healthcare professionals, known as “SNFists,” allows for immediate assessments and minimizes unnecessary hospitalizations. Embracing community paramedicine extends our reach to provide home visits and health services, particularly beneficial in rural areas. We prioritize advance directives to align care with patients’ wishes, offering a more patient-centered approach. Additionally, our commitment to palliative care and hospice ensures a dignified and comfortable alternative for appropriate patients, delivering comprehensive support in their homes. Tuscany Village’s skillset in reducing re-hospitalizations encompasses these ten key strategies, reflecting our dedication to optimal patient care and well-being.