The unthinkable happens. You have been injured or have an illness that severely affects your ability to be independent. And you may find yourself in your own community or another community, far away from what you consider home. And you need time to recover. Now what? You wonder what questions to ask. Well, once your doctor has cleared you after your surgery or hospital stay, you will need time to recover with a transitional care team. That may mean transitional care or home health or maybe private care assistance. It is usually advised that you have that conversation with your physician or the attending physician.

What is transitional care?

Transitional care is provided to a patient when they are well enough to leave a hospital but not well enough to go home. In larger communities, patients who have had surgery or an extended illness would leave the hospital and go to a skilled nursing facility or rehabilitation.

The skilled nursing facility would be comprised of nursing, physical therapy, occupational therapy, speech therapy and a dietitian. In rural areas like Grant County, this service is provided at Blue Mountain Hospital, a critical access hospital, and is called transitional care.

Following our mission of providing quality care close to home, patients do not have to rehabilitate away from their home town. Instead, through this program, they can stay at Blue Mountain Hospital during recovery. This makes it easier on family and friends to visit and keep the patient in or close to familiar surroundings.


Once in a transitional setting, your primary physician continues to play an important role in your rehabilitation, assisting in reviewing and your treatment and support. If you do not have a primary physician in the area, you can choose a physician from Blue Mountain Hospital.

Physical therapy

A physical therapist will be the expert in strengthening, balance training and teaching of assistive devices.

We will work with you to recover from the effects of the illness or surgery and also work with your family or caregiver to make sure they are ready to help when you go home.

Occupational therapy

Our occupational therapist is trained in strengthening, use of adaptive equipment and works closely with the physical therapist and other members of a multidisciplinary team.

Your occupational therapist will work with you and your caregiver to learn ways of adapting to your illness or surgery to aid in bathing, getting dressed and preparing meals.

Registered nurse

Your registered nurse will monitor your vitals, administer medications, follow the treatment plan of the doctor and, if required, perform wound care.

The RN will also be providing valuable education (regarding medications, wounds, etc.) to both the patient and caregivers to ensure a safe return to home.

Speech therapist

Your speech therapist provides an intervention that is focused on improving your speech and abilities to understand and express language, including nonverbal communication. Speech therapists and speech pathologists (SLP) are the professionals providing those speech services.

Registered dietitian

A registered dietitian is your most credible and reliable source for accurate nutrition information, trained in the use of nutrition to prevent and control disease.

Registered dietitians help people learn about staying healthy and selecting the right foods. Balance, variety and moderation are keys to healthful eating. A registered dietitian can help you find a total eating plan that works for you and your lifestyle.

Respiratory therapy

Your respiratory therapist will assist the team by giving breathing treatments, if necessary, and monitoring your vitals to ensure a speedy recovery. The respiratory therapist is not always involved in all cases.

Discharge planning

Discharge planning is a process that aims to improve the coordination of services from the hospital, by considering the patients in the community. A trip to the hospital can be an intimidating event for the patient and their family. Patients, family, caregivers and health care providers plan roles in maintaining a patient’s health after discharge.

If you or a loved one ever find yourself out of town for a surgery or illness, talk to the health care provider and let them know you want to recover close to home. We’d love to get you back on your feet. For more information, call or stop by and meet our Discharge Planner Bill Hodgson, 541-575-1311, ext. 2331.


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