Behavioral health services include:

• Ongoing mental health assessments, case management, medication management, safety assessment, development of individualized patient Plan of Care including clinical findings
• Extensive training and collaboration with local programs such as CT Behavioral Health Partnership, Community Health Network (CHN), and Area Agency on Aging of South Central Connecticut (AOASCC) for obtaining authorization for home health care services
• Monitoring effectiveness of medication regimes
• Collaboration local residential facilities, and intensive outpatient therapy, drug and alcohol rehabilitative services
• An experienced team of psychiatric nurses  

Additionally, we can offer IV, oncology, cardiac, acute medical nurses who collaborate with behavioral health to provide our dually diagnosed patients with the very best home care has to offer.

Our cardiac care staff has extensive experience in cardio-pulmonary care and rehabilitation. They provide specialized services to patients with a wide range of acute and chronic conditions. The cardiac care staff is part of an interdisciplinary team that includes community health nurses, medical social workers, home health aides, and physical, speech and occupational therapists.

For each patient referred to us, we can provide:

• Assessment of patient’s physical and mental health
• Ongoing assessment and evaluation of the care plan
• ProTime monitoring
• Telemonitoring
• Weight monitoring
• Monitoring of heart rate and blood pressure pre- and post activity
• Oxygen saturation monitoring
• In-home respiratory therapy instructions
• Patient and family teaching and guidance
• Interdisciplinary conferences with physicians and other health team members
• Referral to and coordination of community resources and ancillary programs
• Specially trained home health aides to assist with personal care needs
• Monitoring of weight, blood pressure, heart rate and oxygen saturation through visits with patients and our telehealth system
• Provide IV inotropics and IV lasix
• Patient and family teaching guidance
• Experienced with life vests and LVADS

Home health aides are part of our interdisciplinary team under the supervision of the patient’s nurse. They provide personal care to patients recovering from surgery or that have chronic medical conditions that limit independence. Registered nurses make regular visits to assess and modify patient care plans, and are accessible around the clock to home health aides for supervision and support.

• Assistance with personal hygiene like bathing
• Assistance with dressing
• Assistance with toileting
• Assistance with transferring
• Hoyer lift transfers
• Reminders for medication

Home infusion therapy allows patients to receive vital fluids and medications without the inconvenience or costs of a hospital visit. Our home infusion team specializes in a full range of IV therapies for patients with chronic and acute illnesses. They are supervised by a CRNI specially trained and dedicated to intravenous therapy.

Our team of IV specialty nurses combines their assessment skills, technical expertise and community health experience in trea­ting patients with cancer, HIV/AIDS, nutritional deficiencies, bone marrow inflammation, leukemia, heart disease, hemophilia and other health problems.

The team can also provide comprehensive care management, follow-up reports to physicians, patient and family education, peripheral intravenous site rotation, IV site care, psychological support, home infusion therapy, and central line catheter care.

Adult and Pediatric Infusion Therapies:

• Antibiotic therapies
• Anticoagulant therapies
• Anti-fungals
• Anti-virals
• Cardiovascular therapies
• Chelatin therapy
• Chemotherapy
• Colony stimulating therapy
• Cystic Fibrosis therapy
• HIV-related therapies
• Hydration
• Pain management
• Total parental nutrition
• Transplant therapy

Patients can pre-book their care with Home Care Plus - South Central Connecticut prior to a scheduled surgery. Your surgeon simply has to send us a referral with the plans for surgery and we can schedule post-op care in advance so your mind is at ease. Call us for more information, 203-777-5521.

Patients can take advantage of all of our rehab department has to offer, in coordination with your surgeon.

Home Care Plus - South Central Connecticut provides physical therapy, occupational therapy and speech therapy to patients through our rehabilitation and therapy team. Our nurses and home health aides will assist in nursing needs for patients recovering from a major surgery.

• Our therapy program is focused on increasing strength and mobility
• Education and teaching of safe techniques for activities of daily living (ADLs)
• Home safety evaluation of exterior and interior of home
• Wound care and monitoring of incision site
• Medical reconciliation and nursing evaluation of associated balance issues
• Recommendations for home modification and durable medical equipment (DME)
• Development of a written and illustrated home exercise program
• Home health aide for assistance with personal care
• Removal of surgical staples
• PT/INR values
• Teaching of maintenance programs after discharge

Our maternal child health team includes registered nurses with a foundation in community health, and experience in routine and high-risk obstetrics. Our nurses assess each patient’s needs and provide access to other community-based services to help mothers-to-be through pregnancy to term.

Services provided may include physical assessments, birth and infant care guidance, lactation education, assessment of fetal heart rate, medication teaching and administration, referral and coordination of community resources, and related programs. Postpartum visits are also available to mothers and infants who have been discharged early, have questions, or are at high risk.

For each patient referred to us, our team will manage complex obstetric conditions, such as:

• Hypertensive disorders in pregnancy
• Gestational diabetes
• Preterm labor
• Hyperemesis
• Pre-existing medical conditions
• High-risk social situations: substance abuse, teen pregnancy
• Postpartum depression

The medical social work team works closely with our nurses, therapists and home health aides. Our team addresses the social, economic and emotional issues relating to illness or injury and lessens the impact on an individual’s medical condition, treatment plan, or rate of recovery.

For each patient referred to us, we can provide:

• Crisis intervention
• Assessment of biopsychological functioning
• Depression prevention and counseling for depression
• Referrals to community resources
• Long-term care planning
• Education and support for patients and families
• Assistance in optimizing payer sources
• Assistance in reducing unnecessary re-hospitalizations

Palliative care can begin with a new diagnosis and treatment for a potentially life-limiting illness. It is medically focused on relieve of pain, symptoms and stress of a serious illness or treatment side effects. It is also focused on the patient and families psychological, social and spiritual choices.

Our goal is to supplement the care provided by the patient’s physician and primary treatment team. We want to help people live comfortably and to provide the best possible quality of life for patients and their families. Our oncology clinicians are chemo-certified and experts in the field.

Palliative Care can incorporate:

• Relief of symptoms including pain, shortness of breath, fatigue, constipation, nausea, loss of appetite, numbness and problems with sleep due to illness or treatment
• Patient and family support regarding diagnosed illness and treatment choices, advanced care planning and guidance to other community resources

Home Care Plus - South Central Connecticut provides physical therapy, occupational therapy and speech therapy to patients through our Rehabilitation and Therapy team. Our nurses will assist in nursing needs for patients recovering from a major surgery or a health decline.

• Our therapy program is focused on increasing strength and mobility
• Education and teaching of safe techniques for activities of daily living (ADLs)
• Home safety evaluation of exterior and interior of home
• Wound care and monitoring of incision site
• Medical reconciliation and nursing evaluation of associated balance issues
• Recommendations for home modification and durable medical equipment (DME)
• Development of a written and illustrated home exercise program
• Removal of surgical staples
• PT/INR values
• Teaching of maintenance programs after discharge

For every patient referred to our agency, we conduct a home safety evaluation and create a comprehensive care plan. If you or your patient notices any of these indicating they could benefit from our rehabilitation and therapy services, please contact us today!

Breathe easier with the assistance from our team of pulmonary experts. Our clinical team will implement a comprehensive care plan for Chronic Obstructive Pulmonary Disorder (COPD) patients with the goal of reducing hospital readmissions and emergency room visits. Our pulmonary program started as a study with a local hospital using our proprietary protocols and now we are accepting all patients with a COPD diagnosis to the program.

Our COPD program includes:

Skilled nursing services are generally covered by Medicare, Medicaid, and most insurances when given on a part-time or intermittent schedule. To receive this benefit, care must be medically necessary and ordered by a doctor. Skilled nursing services are provided by either a Registered Nurse (RN) or a Licensed Practical Nurse (LPN). Home health nurses provide direct care and teach the patient and caregivers about the appropriate care for the illness or injury. The nurses will also manage, observe and evaluate the care.

Examples of skilled nursing care include:

• Teaching/administering medications, injections, or tube feedings
• Teaching how to care for wounds and monitoring their healing
• Teaching about prescription drugs or diabetes care

Any services that can be done safely by a non-medical person without the supervision of a nurse, are not considered skilled nursing care. Home health aide services may also be covered in conjunction with skilled services such as nursing, physical therapy, occupational therapy, or speech therapy.

We offer a state-of-the-art wireless telehealth system to patients with high risk diagnoses. The system enables patients to monitor their blood pressure, oxygen levels, heart rate, and weight as well as have an emergency response system placed in the comfort of their home.

The data collected via the telehealth system is sent to our clinical team over the wireless signal and reviewed daily by their nursing team. If there is an out of parameter vital sign, the nurse manager is alerted through the system and we are able to triage the necessary follow up.

For many of our patients, their care begins with a referral from a hospital or rehab facility. Our care transition specialists are available to meet with patients before they go home, helping them and their families to prepare for a successful home care experience. More than a simple meeting, this service enables patients and families to have a clear understanding of what to expect, what resources are available to them and the preparation necessary to get the most from their home care experience.

Our team of clinical and community liaisons help patients feel comfortable and confident upon leaving the hospital or skilled nursing facility before returning home. Our liaisons can meet a patient in an in-patient setting and evaluate any outstanding steps in the discharge process – eliminating any negative consequences on the patient’s health, quality of life or patient satisfaction with care.

The goal of our program is to maintain the continuity of care from in-patient care to home care.

• Assistance in the development of a plan of care prior to discharge
• Education for the patient regarding their home care needs and services
• Confirmation of medications
• Review of ADL capabilities
• Assessment for fall risk
• Discussion of family involvement
• Assistance in scheduling follow-up appointments with primary care physician and specialists

Home Care Plus - South Central Connecticut is unique in having a Wound, Ostomy, and Continence Nurse (WOCN) on staff. Our certified WOCN uses evidenced-based practice standards in relation to specific wound management issues, resulting in improved healing times, wound closure rates and associated costs as well as fewer emergency room visits and fewer hospital readmissions.

Our WOCN makes sure our staff maintains a vast knowledge of the newest wound care products used to reduce pain, improve outcomes and decrease wound infections, collectively decreasing the need for emergent care due to deteriorating wound status.

For each patient referred to us, we can provide:

• Assessment of a patient’s wounds and comorbities
• Nutritional assessment in relation to wound healing
• Instruction in diabetic management to promote faster wound healing
• Education on pressure ulcer prevention
• Referrals to DME companies
• Referrals to community resources, such as wound care centers/clinics
• Patient and family teaching in regards to prevention of additional wounds