The most dangerous weeks of recovery, made safe at home
Surgery went fine. The risky part is the ride home: new medications, weak legs, vague instructions and an exhausted family. Our transitional care program turns those first weeks into a supervised, structured recovery, which is why 96 percent of our recovery clients stay out of the hospital.
What transitional care includes
- Pre-discharge coordination with the hospital team, before the wheelchair ride to the curb
- Day-one nursing visit with full medication reconciliation, the top readmission preventer
- Wound and incision care with photographic tracking your surgeon can review
- Red-flag monitoring: the specific warning signs for your procedure, checked every visit
- Physical and occupational therapy sequenced to surgeon protocols
- Aide support for bathing, meals and mobility during weak first days
- 24/7 nurse line so 2 am questions get answers, not ER trips
Built for joints, hearts and everything between
We run recovery programs for knee and hip replacement, spine and shoulder surgery, cardiac procedures and CHF discharges, pneumonia and COPD stays, strokes and major abdominal surgery. Each follows the surgeon's protocol, and each ends the same way: a graduation visit where the nurse, the family and the patient agree the recovery is done, and what support if any should continue.
Helpful guide: Our printable Hospital Discharge Checklist walks you through exactly what to ask before leaving the hospital.
Questions about recovery at home
Why are the first two weeks home so dangerous?
Nearly one in five Medicare patients historically returns to the hospital within 30 days, and most of those returns trace to preventable causes that surface at home: medication mix-ups between hospital and home lists, missed warning signs, falls during weak first days, and no one to call until it becomes an ER trip. A structured transition plan attacks each of those causes directly.
When should we contact you, before or after discharge?
Before, ideally as soon as surgery is scheduled or admission happens. We can attend discharge planning, receive orders directly from the hospital team, fill prescriptions before the ride home and have a nurse or caregiver at the house on day one. Families who call us before discharge have dramatically smoother first weeks.
What does Medicare cover after surgery?
With a physician order, Medicare typically covers skilled nursing visits, physical and occupational therapy and home health aide visits at 100 percent during recovery. Many families add private-duty hours for overnight presence or extra help in the first week or two; we quote those in writing.
Do you work with the hospital's discharge planner?
Every day. Discharge planners and case managers at Las Vegas hospitals refer to us because we respond same-day, see patients within 24 hours, and send documentation back. You can simply tell your discharge planner you want In-Home Care Las Vegas, by name. Choosing your home health agency is your legal right.
Care can begin within 24 hours
Talk with a registered nurse today. No pressure, no obligation, just honest answers about what your family needs.
Prefer to talk it through first? Call (702) 555-0142. A real person answers, 24 hours a day.