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Transitional Care

Your Care Team

A team of healthcare professionals will work with you to help achieve your care goals and help prepare you for discharge.

 

You may have a new Physician once you are admitted to the transitional care unit. However, since your condition is now stable, you may see your physician less often than before.

 

A Social Worker will help you to access community resources for support as you prepare for discharge.   

 

An Occupational Therapist will help develop a plan for what you need to maintain independence and mobility, including equipment such as a walker or a wheelchair. They can also help you learn to use your equipment properly and safely so you can participate in daily activities.  

 

Physiotherapists will provide treatment and exercises to keep you mobile. These therapy sessions will focus on maintaining the progress you have made, and will be less frequent (three times per week for 15 to 20 minutes each).  

 

Registered Nurses and Registered Practical Nurses will meet your health needs, , administer medications, and identify and inform your physician of any changes in your condition.

 

Personal Care Attendants will help you with day-to-day activities, including assistance with bathing, dressing and companionship services, among other tasks. 

 

Other health professionals such as Speech Language Pathologists and Registered Dietitians are available depending on your specific needs.

 

Spiritual Care at Bruyère provides support to patients, families, and staff to help build and sustain spiritual and emotional well-being in the face of challenging and difficult health journeys. Chaplains, both clergy and lay, provide professional spiritual care services related to emotional and/or spiritual health. Speak to your care team if you would like to speak with a Chaplain.

 

We strongly encourage, with patient consent, that families be involved in care planning and assisting with the day-to-day personal support needs of patients. Helping during mealtimes, bringing in proper footwear for safe mobility, and doing a loved one’s laundry are all ways family members can help support a patient during their stay. This may also help to build some healthy routines for after discharge.