Geriatric Competent Care Care Transitions Intervention by Eric Coleman

This webinar presents some of the core competencies on how to best prepare and ease the difficulties surrounding care transitions, particularly to and from a hospital environment for adults with dementia. A transition of care is defined as moving from one practitioner or setting to another as condition and care needs change (Coleman and Boult, 2003). It is usually accompanied by a change in care plan. This transition can take place within settings (e.g. within the home care team), between settings (e.g. between a hospital and home) and across health states (e.g. curative and palliative care). During transitions of care, communication — between the individual with dementia and his or her family, within the home care team, and among all providers involved in caring for the person — is especially important to ensure medication safety, understanding of the care plan, clarity of roles and responsibilities, and care coordination.