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presented by Georgia Hockenjos, BSN, RN
Financial: Georgia Hockenjos receives compensation from MedBridge for this course. There is no financial interest beyond the production of this course.
Non-Financial: Georgia Hockenjos has no competing non-financial interests or relationships with regard to the content presented in this course.
Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.
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Georgia Hockenjos, BSN, RN
Georgia Hockenjos, BSN, RN, is vice president and COO of Aleckna and Associates, Manalapan, New Jersey. Ms. Hockenjos has more than 40 years' experience in the home care industry, with more than 15 years in a management or director-level position at a large multibranch nonprofit home care agency (VNA) and 20 years as vice president…
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1. Care Transitions, Discharge Planning, and Complex Care Definitions
This chapter introduces and defines the concepts of discharge planning, transitions of care, and complex care to ensure the terminology is consistent and understood throughout the course.
2. Conditions of Participation: Discharge Planning
This chapter is a thorough review of the Medicare Hospital Conditions of Participation § 482.43, which describes discharge planning. It includes identification of patients in need of discharge planning, the evaluation, components of the plan, and reassessment requirements.
3. The Process of Discharge Planning
This chapter utilizes the care planning process as a framework for developing an effective discharge plan. The steps included in the process are conducting an assessment, developing the plan, implementing the plan, and measuring the success or outcomes.
4. Case Scenario
This chapter is a review of an 85-year-old patient with multiple diagnoses and complex care needs who is being discharged to home. The steps involved in developing, implementing, and measuring the discharge plan to home—and, ultimately, to hospice—are discussed, with the goal being to include all the concepts discussed in the course.
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