Constance Provides Virtual Non-medical Social Support Post-Discharge for Complex Care Management, Improving Quality of Life and Reducing Risk of Rehospitalization for Patients

A patient-centered, virtual care management model ensures older adults with complex needs thrive at home post acute and subacute care. This is even more true during the COVID-19 pandemic. Our Constance team had confidence there would be an immediate, measurable impact on the amount of time required of providers to fully support older patients discharged with multiple health issues. Constance proved successful in supporting the recuperation of patients at home while saving staff time and preventing negative health outcomes.

Constance provided its person-centered, virtual social support system to help a patient with multiple health issues recover and lower their rehospitalization risk.

Nurses and social workers providing in-patient care are typically not tasked with following-up with patients post-discharge due to lack of time and resources. Information about a patient’s status at home, however, can be key in ensuring a successful recovery and preventing rehospitalization. Many patients struggle to follow their discharge plan of care, including medication management, physical therapy adherence, or primary care physician follow-up which may lead to significant decline. Without frequent, proactive post-discharge follow-up, recently discharged patients may be at risk of poor outcomes and rehospitalizations.

Constance Family Coordinators quickly provided post-discharge needs assessments, intervention plans, and active meaningful support for complex-care patients. Often they addressed Social Determinants of Health, including:

  • Food insecurity
  • Low income
  • Access to healthcare
  • Availability of support services
  • Affordability of medications 
  • Anxiety and stress

Download the full case study and learn about how Constance can help healthcare providers save time and money, improve post-discharge outcomes for patients, and ultimately their quality of life, especially those with complex care needs.

Reach out to our team to learn how we can help your organization improve post-discharge patient follow up. Email us at hello@constance.one or call us at (717) 500-1386. We look forward to hearing from you!

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