Safe Transition Home Program

Preventable Hospitalizations.

People with chronic conditions are the users of over 75% of hospital days, doctor’s office visits, home health care and prescription drugs and are the most likely to have preventable hospitalizations.

People with chronic conditions often have poor management of medication because they do not always communicate about all of the medications they are taking; there are often prescriptions from multiple doctors. This is a complex problem that results in nearly 700,000 emergency department visits for adverse drug events in the U.S. for adults age 65 or older.

According to the Center for Disease Control and Prevention, Up to 59 percent of those on five or more medications per day are taking them improperly.

  • 22 percent of Americans take less of the medication than is prescribed on the label.


  • 23 percent of nursing home admissions are due to patients failing to take their prescription medications accurately.


  • 24 percent of prescriptions written by a doctor are never filled.

Who Will This Benefit?

People with chronic conditions are also the ones that could benefit the most from care coordination and medication management.

Care coordination is a core function of the patient-centered model of care. The six aims of the transitional care model are:

  • Timely – avoid unnecessary delays


  • Safe – prevent harm to patients from medical or administrative errors


  • Effective – using scientific knowledge, execute well to maximize benefit


  • Patient-centered – Respond to patient and family needs and preferences


  • Efficient – avoid unnecessary duplication of services; ensure benefit to patient


  • Equitable –availability and quality does not vary from patient to patient.

The Aging Life Care Managers at Integrative Elder Care LLC help address these complex issues with our clients and their physicians, and find solutions to improve medication management and compliance. Older adults can avoid visits to the emergency room and reduce their readmissions through medication management, patient and family education and careful coordination with all providers of care.

Integrative Elder Care Management

Are you a child of or an elder care patient yourself? Are you seeking better arrangements? We have many options to assist you.

Integrating With Other Professionals

Are you a professional working with an elderly client? Integrated Care Services has a number of services to assist you.

Safe Transition Home Program

Our Safe Transition Home program is an umbrella of services we offer to help transition and protect a patient once their back home.

Late Life Relocation

When it comes to late life decisions, we can never have too many options. We help you choose the best providers for your needs.