As the boomer population ages, more people are called to serve as caretakers for their parents. Yet many such caretakers don’t have the skills to meet the needs of patients who are newly released from the hospital.
When patients leave the hospital, they hope they’re on the road to recovery. For too many, however, that road becomes winding and bumpy, detoured by a gap in care that exacerbates their illnesses or leads to other compounding health issues. And, before long, patients find themselves back in the hospital rather than at home.
Mark Toles, an assistant professor in the UNC School of Nursing, had an idea that could help solve this problem. His plan brought more questions. Who could help him move his idea forward? What resources are available? What funds might be out there? And how might he balance his teaching and research responsibilities with a desire to turn his idea into something real?
Toles found answers to these questions — and his passion for innovation and entrepreneurship — by working with Innovate Carolina on a program he designed to keep patients healthier after they leave the hospital. His evidenced-based transitional care process Connect-Home helps patients and their caregivers manage serious illnesses at home. The goal is to improve function and prevent re-hospitalizations.
Toles is partnering with Lutheran Services in America to implement Connect-Home, a set of protocols and tools that guide post-acute care providers through a four-step process. This step-by-step process prepares patients and their caregivers for their transition home.
The problem Toles is tackling isn’t a small one. Each year, more than 1.5 million adults are discharged from a hospital to a nursing facility for post-acute care before going home. Often, they need nursing care and rehab therapy for a few weeks to resolve medical problems and get stronger. Many patients may require complicated care at home during the transition back to full health, and their caregivers may not have the medical knowledge they need to provide adequate care.
As a nurse practitioner, Toles understood the challenge of transitional care. He saw his idea for Connect-Home as an answer. Like many faculty, he wasn’t sure how to take the next step.