My After Nursing Home Care Plan

Resource Location: https://drive.google.com/file/d/1CP1eEv5dT-0zFwR4r8XpMU-ybLySx4Jq/view?usp=sharing

Discharge Planning tool completed by nursing home interdisciplinary teams with the patient and caregiver throughout the discharge planning process. Adapted based on materials from Agency for Healthcare Research and Quality (AHRQ), Project RED (Re-engineered Discharge), and the Coleman Transitions Intervention in support of the Special Innovation Project: Improving Nursing Home Discharges Back to The Community Implementation Guide.