.png)
GMCH at Home
What is GMCH at Home?
GMCH's at Home provides you with the care you need at home once you are discharged from the hospital. The GMCH's at Home team consists of your coordinator, nurses, personal support workers and social workers in partnership with Bayshore Health Care.
The GMCH's at Home team works closely with you and our hospital team to make sure your care plan at home meets your needs. Our goal is to make your first weeks at home as easy for you as possible.
How does GMCH at Home Work?
What happens before I leave the hospital?
Before you leave the hospital, your GMCH at Home team meets with you, your family and your hospital team to create your care plan. This plan will be shared with everyone involved in providing your home care. Your first home visit will be scheduled with Bayshore Integrated Care Solutions (ICS) once you leave the hospital.
What happens when I get home?
On the day you are discharged, you will get a phone call from a member of your Bayshore GMCH at Home team to make sure that you have arrived home safely.
Your GMCH at Home team will:
-
Visit you within 24hrs of your arrival home
-
Your care team will check in with you regularly to ensure your care plan meets your clinical needs.
-
You and your care team will continue to decide how often they will check in with you.
-
Work closely with the hospital to ensure your goals are being met after you get home
-
Use different ways to check in and care for you:
-
Home visits
-
Phone calls
-
Technology like telemonitoring
-
-
Work with other local community resources including Meals on Wheels, transportation and caregiver support programs
If your needs change, so will your care plan. You may need more services at times or you may need less. GMCH's @Home was designed with this flexibility in mind.
These supports are there so you have what you need to be at home.
There is a 24/7 phone number that you call if you have any questions or concerns when you are home:
How long does the GMCH Home program last?
This is dependent on the patient. GMCH offers three different programs:
-
21 Day Program
-
8 Week Program
-
16 Week Program
When does GMCH at Home begin?
Patients are contacted by Bayshore ICS to create a plan for service that best fits their needs immediately after being discharged from hospital.
What happens if I need to be readmitted to hospital?
If your medical condition changes and you need hospital care, GMCH at Home will continue to support you when you return home after your hospital stay. Your GMCH at Home team will be kept informed and plan for your transition back home.
What happens if I need ongoing care?
If you need care after GMCH at Home, your care team will connect you with the appropriate community organization to support your ongoing needs. GMCH at Home will ensure you have services in place before discharging you from the program.
What if I don't have a primary care provider (family doctor or nurse
practitioner)?
GMCH at Home will work with getting you onto Health Care Connect to apply for a new Physician.