Chronic Medical Care

The Chronic Medical Care program assists patients with medically complex conditions who are unable to be cared for safely in a lower level of care and need ongoing medical, nursing and multidisciplinary team management.

Services are designed to treat medical conditions, improve functional status and train caregivers so that patients can be safely discharged to the community.
 

Care Team

Providing compassionate and comprehensive care is the primary focus of our experienced team of professionals. Using an interdisciplinary team approach, the professional staff designs an individualized care program to address the patient’s physical, psychological, social and spiritual needs. The team includes:

• Internal and geriatric medicine
• Physical medicine and rehabilitation
• Neuropsychology/psychology/psychiatry
• Pulmonary medicine
• Surgical consultation (general, plastic, vascular)
• Wound care
• Nursing
• Respiratory therapy
• Physical, occupational and speech therapy
• Therapeutic recreation
• Clinical nutrition
• Social work
• Case management
• Pastoral care
• Hospice/palliative care
   

Admission Criteria

• 18 years and older
• Referred by a physician
• Require intensive nursing services each day
• Require specialized medical care
• Has conditions that do not require acute hospitalization
• Has potential to return to a community setting
   

We Treat

• Advanced COPD
• Pulmonary fibrosis
• Pulmonary effusion
• Cardiac conditions including CHF, coronary artery disease, left ventricular device, post-angiography and stent
• Gastrointestinal complications
• Embolism requiring anticoagulation therapy
• Renal disease
• Immunocompromised conditions
• Complicated diabetes
• Neurological disorders including Parkinson’s disease, multiple sclerosis and seizure disorders, stroke
• Infectious diseases
• Hematology complications
• Post-surgical and medically complex complications
• Wounds and ulcers
   

Treatment Plans

• Intravenous therapy
• Central venous therapy
• Intra articular therapy
• Medication adjustment
• Chest tube, Blakemore and Pigtail catheter care
• Hemodialysis
• Wound care
• Post-surgical care
• Rehabilitation therapy
• Respiratory therapy
• Comprehensive nutritional support services including total parental nutrition (TPN), peripheral parental nutrition (PPN) and nutritional care via feeding tube (Dubhoff)