Care Transitions Resources for Patients & Caregivers

Helpful Tools for Patients

The Discharge Patient Education Tool will help you to work through the details of your discharge plan with your doctor prior to leaving the hospital, helping to make sure you have a complete understanding of all the important details.

"Managing Your Congestive Heart Failure" shows the important facts about heart failure that you need to understand.

A Personal Health Record is a tool for you to use to better self-manage important health information, including health history, medical conditions, medications, allergies and recent hospital and doctor visits. The tool is available in English and Spanish. You should work with your doctor or caregiver to fill out the form.

Ask Me 3 is a program developed by the National Patient Safety Institute to prompt better patient communication with their physicians. This article will help you remember to ask three key questions during your care.

Medication Management Golden Rules gives you the tips and questions you'll need to make sure you understand the medications you're taking and to keep track of your current medications and any changes that are made to the plan.

Hospital Discharge Planning Golden Rules provides tips for communication with your primary care doctor when you are hospitalized and helps you to be involved in your discharge plan before leaving the hospital.

The most recent issue of our Healthy Seniors newsletter is all about improving transitions of care, and includes lots of great information to help you make sure you are getting the care you need when you change from one setting of care to another.

Helpful Resources for Caregivers

The Care Transitions Initiative Fact Sheet for Caregivers gives a one page overview of the effort to improve care transitions and how the family caregiver plays a key role.

The Medicare Web page for caregivers offers a wide variety of tools and helpful information to help caregivers work through their loved one's episode of care.

The National Family Caregivers Association (NFCA) educates, supports, empowers and speaks up for the more than 65 million Americans who care for loved ones with a chronic illness or disability or the frailties of old age. NFCA reaches across the boundaries of diagnoses, relationships and life stages to help transform family caregivers' lives by removing barriers to health and well-being.

Next Step in Care provides easy-to-use guides to help family caregivers and healthcare providers work closely together to plan and implement safe and smooth transitions for chronically or seriously ill patients.

Hard Choices is a site that offers information and education on the difficult process of making end of life choices for loved ones.