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Continuity of Care

Ensuring patient care after a hospital stay

When you or a loved one is preparing to return home after a hospitalization, there are people to help make the transition easier.

The Nurse Case Managers and Social Workers of the Continuity of Care team are compassionate professionals who prepare patients and their families in making arrangements to leave the hospital and find the resources and support services needed to do so safely and smoothly.

Case Managers: Personal Help in Moving Ahead

Each patient admitted to the hospital has an assigned nurse Case Manager to coordinate the services you may require after discharge from the hospital. The Case Manager will work with you and your family, as well as you doctor and other members of the health care team to develop a discharge plan that meets your needs and ensures a smooth transition from the hospital to home or other appropriate setting.

If needed, the Case Manager can assist you in setting up services such as visiting nurses, home medical equipment, or transfer to a rehabilitation facility. The case manager will also work closely with your insurance company regarding the coverage of your stay and medically necessary follow-up services.

Social Workers: Supportive Assistance for Patient Needs

Social Workers at Lowell General Hospital address the emotional and social concerns of patients during their hospital stay. Services offered include supportive counseling for patients and their families, referrals to appropriate community resources, and assistance with decision making regarding discharge planning. Our Social Work staff is an integral part of the interdisciplinary team who collaborate with doctors, nurses and other ancillary services to ensure that plans incorporate the patient's social and emotional needs. They also act as the patient advocate with treatment providers and outside agencies.

If you or your family have any questions regarding discharge planning or services that may be needed, please contact the Continuity of Care Department at 978-937-6308, Monday through Friday 7:30pm to 4:30pm.

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