14-Day Hospital-to-Home RN Program

What’s Included in Your 14-Day Program

• Preparation & Arrival-Home Check

  Before discharge, where possible · On the day you return home

  When arranged before discharge, we include a 20–30-minute preparation call and information review, followed by a brief 10–15-minute arrival-home call. We review your existing supports and check that essential medications, equipment, transport and help at home are arranged. These calls are additional to your three scheduled virtual check-ins.

• Initial RN Home Assessment

  One 60-minute appointment · Timing confirmed before the program begins

  We aim to arrange your first visit within 24 hours of discharge; a visit within 48 hours may be appropriate following review of your care needs. Your RN reviews the discharge instructions and medications actually being taken, assesses relevant symptoms and baseline observations, screens for home-safety concerns, and helps you and your caregiver understand the next steps.

• 2 Follow-up RN Home Visits

  Two 60-minute appointments · Usually around days 4–5 and 10–12

  Your RN reassesses recovery, follows up on earlier concerns, and provides relevant monitoring and education. Depending on your needs, this may include surgical-site or wound monitoring, vital signs, symptom review, and checking how you are managing daily activities. Visit timing is adjusted to your assessed needs and discharge plan.

• 3 Scheduled Virtual RN Check-ins

  Around days 3, 7 and 14 · By telephone or video

  Two 15–20-minute check-ins help review symptoms, medication questions, follow-up arrangements and caregiver concerns. Around day 7, we also review whether you need additional or longer-term support. Your third check-in is a 20–30-minute day-14 transition review, included in this total.

• Medication Follow-up, Care Coordination & Family Updates

  Throughout your agreed nursing care plan

  We identify medication discrepancies and follow them up with the appropriate pharmacist or prescriber, help organize appointments and existing home-care services, and communicate relevant concerns to your healthcare team. We track outstanding questions and next steps. With your consent, we provide concise family updates after home visits and when the care plan changes.

• Scheduled RN Support & Recovery Guidance

  Appointments available between 8 a.m. and midnight

  Your scheduled telephone or video appointments can be arranged within these hours, subject to availability. We confirm how to contact your RN and the arrangements for follow-up before your program begins. You receive clear guidance on whom to contact for routine questions, concerns needing prompt assessment, and emergencies. This is appointment-based support, not emergency or on-call coverage.

• Your Written Home Plan & Day-14 Handover

  A practical plan during your program · A clear next step at completion

  Receive a plain-language plan outlining agreed priorities, relevant symptom instructions, appointments and key contacts. During the day-14 check-in, we review progress and provide an updated summary identifying outstanding concerns, who will follow them up, and your ongoing care arrangements. Relevant information is shared with your care team and family with appropriate consent.

Care matched to your needs. The schedule is a starting plan and may change following assessment. We work alongside your hospital, primary care, specialist and home-care providers. Daily nursing procedures, personal care or continuous supervision require a separate care arrangement. Any additional services and costs are discussed before you agree. For a medical emergency, call 911. Do not wait for an RN appointment when urgent help is needed.