Being Discharged from Hospital to your Home? Is the AHS Self Managed Care Program an option?
Need Help at Home?

The AHS Self Managed Care program is one option to look at when you need care at home. Being Discharged from Hospital to your Home can be a very intimidating process for many people, especially seniors. Harmony Caregiving realized that many people, particularly senior’s end up returning to the hospital many times if their transition home is not made comfortable.

Certified Health Care Aides help make this experience so much nicer for the person returning home, as well as their loved ones who will be receiving them into their care from the hospital. Harmony knows all too well, that when this comes to an elderly senior caring for their elderly husband or wife of many years, the experience can cause what is known as Caregiver Burnout, also known as Caregiver fatigue.

Hospital to Home Transition program includes the following to ensure your safety, peace of mind and speedy recovery in the comfort of home and helps you or your loved one avoid those common return to emergency visits that happen all to often, especially in seniors.

To help prevent any of the situations or challenges that can arise, you will have a Designated Hospital to Home Nursing Care Manager from Harmony Caregiving. Harmony will meet you, your loved ones and your Alberta Health Services Home Care Case Manager in the hospital to discuss your care needs for home.  

Your Alberta Health Services Case Manager and Hospital Transition Coordinator meet with you, your family and your Harmony Home Transition Nurse to discuss your options for discharge, and the level of care and program that best suits your needs based on assessment. It is through this process, that the care plan is determined, and who will be responsible for each specific task .

Harmony Home Transition Team alleviates anxiety and stress by making certain you have everything you need taken care of before you even arrive back home.  New prescriptions are blister packed and picked up, fresh groceries are purchased, paying attention to any new dietary recommendations, your Caregiver makes sure you have clean linens and laundry.

The schedule is pre-arranged based on the amount of care you and your care team determined necessary. They are available for three hour visits around specific times, or for around the clock care to ensure your safe arrival, set up and safety through the day, and/or through the night. The amount of time, and time of day is often dependent upon the amount of services and supports Alberta Health Services has assessed you are eligible for, and what you and your family determine is needed.

It is up to the family to decide if additional private services in and above what is offered is cases, is contracted and paid privately to a private home care agency such as Harmony Caregiving.

Rest assured, you are not alone in this journey. After we meet you in the hospital, we begin matching you with the support team you need to carry through with a successful recovery at home. What does the day of transitioning home look like? There is never a time given, prior to the day of, so quite often your transition team is on standby.

  • In the hospital, on discharge day, Harmony staff come to your hospital room to pack your belongings, ensure you have all of your discharge papers and instructions .
  • Your Caregiver will help to ensure you are dressed for the weather, and will bring a wheelchair for the long walk to the car.
  • They help you get in and out of the car, walk you right to your door, help you get into your home, up any stairs and help you get settled in your bed.
  • Our Transition Nursing Care Manger meets you in your home right after you leave the hospital to ensure you are comfortable, discharge instructions are part of the care plan and that your home is safe for you in your recovery state.
  • If something is missing, IE washroom supports, we can help coordinate that with AHS through the Alberta Aids to Daily Living (AADL) cost-share program.

This assessment done by our Nursing Care Manager helps alleviate the risk of you falling, over or under-dosing your medications, prevents you getting infections, and overall allows you to get better rest with all of the comforts of your own home, with a certified health care professional around the clock to ensure your health, physical safety and overall well-being.

Allow Your Loved One to Rest and Recover
from the Comfort of Home

Explore Our Home Care Services

Home is where the heart is. It’s where you should recover after a visit to the emergency room. Unfortunately, it’s difficult for many seniors to return to assisted, supportive or independent living during their recovery, if they don’t have family readily available to help with the extra care.

At Harmony Caregiving we want to make your hospital to home transition as smooth as possible. Your needs are prioritized, and documented in a specific personalized care plan that ensures your needs are top priority. Our professional team will help you transition to an individualized care program and help connect you to programs, resources, and the various funding programs available to help cover the costs.

Do you need hospital to home care transitional assistance?

From Hospital to Home

Following a visit to the hospital or emergency room, many seniors require additional care to help recover and avoid relapsing or being readmitted. Unfortunately, many family members are so busy trying hard to manage their own lives of being a parent or parents yourself.

Welcoming You Home

Rehabilitative care at home is ideal for patients who are being discharged from the emergency room following a fall or stroke but still requires additional support to finish healing, but do not want to stay in a rehabilitation hospital to do so. Transitional care is key in preventing relapses or re-admittance and promotes faster recovery.

Transitional home care is more than simply bringing you home from the hospital. It provides you with the support you need from home heath care professionals to help you heal in the comfort of home. Transitional care provides you with:

  • Safe transportation home from hospital to home
  • Licensed, Bonded & Insured Caregivers
  • Memory Care Trained
  • Introduction to a private Occupational Therapist, Massage Therapist, Physiotherapist if requested.
  • Head to toe personal care services
  • Medication Management including Pharmacy Medication Pickup
  • Toileting & Incontinence Care
  • Showering & Daily Bed Baths
  • Safe Transferring & Mobility Assistance
  • Meal Assistance Including Dietary Recommendations
  • Catheter Care     
  • Ostomy Care
  • Wound Care

   Additional Services to support clients:

  • Appointment Accompaniment
  • Grocery Shopping
  • Meal Preparation
  • House Cleaning
  • Errand Running

Transitioning from hospital to home can be difficult, especially for the elderly. We’re always ready to work with you to customize your transitional living plan so that it fully meets your needs. Don’t worry about the transition; we’re here to help you or your loved ones take care of everything.

Why Choose Harmony Caregiving?

Our home support services and transitional assistance are here to provide you the hands on support and training you and your loved one need to feel safe and supported through every stage of your journey. Our professional senior care provides you with:

Professional, Loving Support

Our hiring and training process ensures that your care is provided by the AHS approved Health Care Aide curriculum. With our HCA Educators and Trainers, you can be certain that your staff are trained and certified professionals. Our team of Licensed Practical Nurses and Certified Health Care Aides provide some of the most thorough and reliable senior home care in Edmonton.

Smooth Transitions

Following a surgery or extended hospital stay you shouldn’t have to worry about arranging the additional care you need. You need to focus on healing, so leave the transition details up to Harmony. Our team works with you on discharge planning so your transition from hospital to home is relaxing.

Peace of Mind

Are you a primary caregiver? Have you ever left a loved one at home alone during the day? Or stayed up worrying overnight because you just couldn’t be there? You shouldn’t be spending busy days or sleepless nights worrying about your loved one’s well being. Our team of care providers is available to provide in-home, around the clock care so you can continue to live your life at work, and at home. Your loved one will experience relief from anxiety and stress because someone will be there to ensure their every need is met from ensuring proper hydration and nutrition, to proper personal hygiene, safe transferring and lifting measures are adhered to and their other physical and emotional needs are taken care of.

Reliable Service

When it comes to senior care, you need a team that provides outstanding service every time. Consistency of staff, home safety and our clients over-all physical and emotional wellbeing are our primary concerns. This is how our senior home care transitions team promotes the health and safety of our clients in an environment that is most comforting and familiar for them.

Around the Clock Care

Home care isn’t just something you require from 9-5 Monday through Friday. You may need to rely on it around the clock because you are an only child, or the only child living nearby, so the expectation is that you can help out. The reality however, is that in order for you to do that, everything else in your life needs to give including children, work, marriage, your own home etc. Whether you need support during the day or in the middle of the night, our team is ready to give you the care you need. Our services give your loved one access to professional, thorough and loving care 24/7/365.

Complete Customization

We know that your needs are unique, which is why our team will completely tailor your transitional homecare services to your family members needs. Whether you require constant care, medication reminders, physical therapy, meal preparation, errand running, medical appointment accompaniment, or just encouragement to get up and do your range of motion exercises. We are able to help coordinate the professionals such as a private Occupational Therapist to ensure you are set up in your home environment safely. Our Caregivers are there to help them engage in activities that are based on their hobbies, interests, history. For example if your family member was a musician, we really try to play music for them to lift their mood, help ease anxiety and create a feeling of happiness in their lives. We’re there to provide care perfectly suited to your family members needs.

Financial Support

Supporting Senior Home Care Across Alberta

You should be able to hire your own care based on your personal care needs without worrying about the cost. Fortunately, Alberta Health Services has created several financial initiatives to help you access the care you need. Some of these initiatives include the Destination Home Initiative , Self Managed Care and the Invoicing Model. We encourage you to ask your AHS Case Manager about the best options for you based on your loved ones specific circumstances and family situation.

These incredible programs are offered to ensure seniors in Alberta receive the care services they require to continue living and recovering at home. Alberta Health Services offers their basic care services according to assessment; these cover daily, weekly services and can be seen on the AHS website here.

The other programs that are available to the public, based on assessment of needs and availability of space and is managed and determined by your designated Alberta Health Case Manager along with Transition Coordinator if you are coming from Acute Care or a Hospital setting. These programs are called the Destination Home, Self Managed Care or Invoicing program. These financial assistance programs provide funds for you to choose your provider while healing or living at home. These options vary in requirement, for example Destination home will provide a per month dollar amount, to cover your loved on moving home under the agreement that once a a bed in a public long term care facility opens up, you must agree to take the first bed that opens up.

Self Managed Care is available when one has assessed unmet health care needs within AHS Provincial Home Care Service Guidelines. The person must have stable health and predictable care needs; need ongoing personal care and home care support services (e.g., longer-term needs).

According to Alberta Health Services “services that are covered as part of the self Managed Care program include; Personal care, home support services and respite care. Personal care includes assistance with personal hygiene, dressing, toileting, mobilization and transferring, eating, oral care and medication management. Home support services include services, such as assistance with preparing meals, homemaking, and recreation activities. • Respite care includes day, evening or night care to give unpaid caregivers (generally family) a break from caregiving. Self-managed care funds cannot be used for any other services”

This program is for when you decide to stay at home and hire your own Caregivers, manage the payroll, scheduling etc., or according to the Alberta Health Services website you can hire a private agency who handles the payroll, WCB, liability insurance so you do not need to. You will be responsible for the difference between what the funding provides and the costs of private care. AHS offers funding based on a complete needs assessment. Additional information on the Self Managed Care Program can be found here.

The Invoicing Program is similar to the Self Managed Care program, with the exception that you pay for your care upfront, and Alberta Health Services reimburses you with a specific monthly amount, and you then need to hand in the paid receipts to be reimbursed.

Do you receive AHS home care currently? If you believe home is the best option, but don’t feel your loved one is getting the support needed, and you are willing to pay out of pocket for a private agency to care for your loved one, Harmony Caregiving provides nursing care services in addition to those offered by Alberta Health Home Care/ Respite. We help make sure your care needs are met by developing a comprehensive care plan and working in conjunction with the services provided by Alberta Health. Harmony Caregiving works with our clients on the invoicing program, self managed care program and Destination Home program.

Healing at Home

Home is where we all feel the most comfortable. We want you to heal and recover from the comfort of your own bed. Contact us to learn more about your home care and transition options and how to begin healing from home.

SMART Planning for Seniors & Family

Information Sessions

It’s difficult to predict how your needs will change as you transition from independent living into requiring additional support. Fortunately, a group of senior specialists are ready to help you plan for your retirement years. At SMART Planning for Seniors, you can meet with a range of experts including a Lawyer specializing in will & estate planning, Mortgage broker specializing in senior housing, downsizing and mover services and home caregiving and facility options. Are you ready to plan for a SMART future?

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