When you are well enough to leave our care, we’ll make sure you have what you need to go home. A medical provider will write your discharge orders, instructions and any prescriptions for medicines you may need. The nurse will give you a printed copy of the information and discuss it with you and your loved ones before you go. We encourage you to ask any questions or address concerns you may have at that time.
If you are returning home, a nurse from Salem Health may call you within the first several days to see how things are going. These discharge callers are a special team that review medicines and discharge instructions with you and answer specific questions that may have come up after you leave. Please share your concerns and ideas on how we may improve.
Your care management team includes nurses, social workers, and associates who are specifically trained in care coordination and transition planning. At Salem Health, care managers are available at every inpatient unit, the emergency department and many of our clinics.
You, or your designated health care representative, have the right to:
Along with all the members of your Salem Health treatment team, your care managers are:
At Salem Health, transition planning begins the moment you become a patient. As your health care needs change, care managers continually work to review your health care challenges to help you consider services you might need and/or qualify for.
Services your care management team provides:
Short and long-term care planning Services may be funded by federal, state, or local entities, or you may need to pay for them privately. Your care manager can help explain the differences.
Type of care | Intended for patients that need | Care environment |
In-home/ personal | Help with hygiene, dressing, eating and grooming | Typically private services in patient’s home |
Home health | Nursing and medical social work services; can include occupational, physical and speech therapies | Patient’s home |
Palliative | Help with life-limiting, chronic conditions – but not ready for hospice | Patient’s home or care facility |
Hospice | End-of-life care and have life-threatening illnesses | Home, assisted living, adult foster home or intermediate care facilities |
Adult foster home | Some help with hygiene, dressing, behavioral management, etc. | Private, home-like setting, with no more than five residents |
Assisted living community | Help with personal care and medication management, but able to remain independent | Private, apartment-like settings with six or more residents |
Residential care facilities | Specialty care like memory care, but do not require 24-hour nursing care | May have shared and private amenities |
Intermediate care facility | 24-hour medical care | Nursing facilities within a structured setting; rooms often shared |
Skilled nursing facility | 24-hour nursing care with skilled therapies like occupational and physical therapies | Highest level of care |
For more information, please call care management main office at 503-814-1808.