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Sparrow Transitions Home Palliative Care

Sparrow Transitions Home Palliative Care Service is designed to help those facing the challenges of having a life-limiting illness. This program was created to help patients who need symptom management, psychological and social support. Care is provided by specialized Registered Nurses (RN) and Master Social Workers (MSW). Overall care is directed by the individual's physician.

Weekly contacts by phone or home visit by a nurse or social worker to ensure continuity of care and ongoing support. The nurse serves as a case manager by assessing needs, providing nursing interventions, educating each patient and those involved in their care. Patients will also have access to a 24 hour on-call nurse who will provide assistance by phone or direction for more acute care needs that may arise.

The social worker will assess psychosocial needs, provide support, and facilitate referrals to community resources. Addressing advance directives and developing a long-term care plan is another service provided by the social worker.

Goals

  • Optimal quality of life through pain and symptom management
  • Avoidance of hospitalizations through home management of symptoms as appropriate
  • Psychosocial support for patient, caregivers, and family
  • Empowerment of patients and their families through understanding their end of life care options in order to make informed decisions
  • Timely, appropriate referrals to community resources or other services

Who Qualifies for Sparrow Transitions?

  • Individuals with a life-limiting illness who are still actively receiving treatment
  • A life expectancy of a year or less
  • Patient whose physician maintains supervision and is willing to work with Sparrow Transitions

 

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