Management of Complex Conditions
If you have more than one complex, chronic condition — such as heart failure, chronic obstructive pulmonary disease (COPD), diabetes or COVID-19 — managing your care on your own may be a challenge. Johns Hopkins Care at Home’s specialty home health care services can help. Our experienced providers bring the care to you, so you can stay at home, where you are most comfortable.
Our services to manage complex conditions are available throughout Baltimore City, Washington, D.C., and Anne Arundel, Baltimore, Carroll, Cecil, Frederick, Harford, Howard, Montgomery and Prince George’s counties. You will need a referral from your provider to get started.
Gerry and Georgene Stephens: Savoring Life Together After COVID-19
More than 100 nurses, physicians, other clinicians and support staff cared for Gerry and Georgene Stephens, a couple hospitalized for COVID-19 at The Johns Hopkins Hospital—he for three weeks and she for two days. “I was asleep for two thirds of my stay… Yesterday, I went on a 4-mile hike,” said Gerry. Hear what else he, his wife and members of their inpatient and home care teams had to say about the challenging but successful recovery.
Our Services for Management of Complex Conditions
We offer treatment and services for a wide range of conditions, and we choose services specifically for you. Depending on your health needs, you may need one or more types of care, such as:
- Education about conditions, symptoms, medications and possible side effects
- Nutritional counseling to support a healthier lifestyle
- Skilled nursing to regularly assess your health and provide treatment as necessary
- Referrals from our social worker for additional support
- Therapy with our physical and occupational therapists and speech-language pathologists to improve strength, function, communication and swallowing
Learn more about our program and how we can help you:
Why Choose Johns Hopkins Care at Home for Management of Complex Conditions?
We help you manage self-care at home for complex conditions such as COPD, heart failure and diabetes — even all three. Highlights of our services to manage complex conditions include:
Critical care experience
All our home health nurses have extensive experience caring for hospitalized patients, and many have a background in critical care. Other team members have professional licenses, certifications and training in areas such as wound care, cardiac care, respiratory care and diabetes management. You receive care from a team with expertise looking after people with multiple complex conditions.
With Johns Hopkins Care at Home, you have access to a team of health care providers from several fields of medicine, including nursing, social work, nutrition, and rehab services. Our providers work together to develop a care plan tailored to your needs. The team meets regularly to review progress, adjusting the care plan as needed.
Focus on quality and safety
Our home health care program — including skilled nursing services — has received accreditation from the Joint Commission, an organization whose recognition shows that our dedication to patient care meets or exceeds national standards for safety and quality. Our system of quality checks ensures your loved one’s safety for every procedure we provide. See our ratings for quality of patient care at the Centers for Medicare & Medicaid Services (CMS).
Home Management of Complex Conditions: What to Expect
Our team provides high-quality care to help you stay safe and independent at home. Here’s what you can expect when you are referred to us:
- An initial in-home assessment: When we receive your referral, we consult with your provider to understand the diagnosis and orders for the first visit. We schedule a time to meet with you in your home.
- A tailored care plan: We work as a team to create a personalized care plan based on your health needs and goals. The care plan includes the frequency, number and type of home health visits, which can change over time as we monitor your health.
- Patient and family caregiver support: Our team works closely with you and your loved one to provide education and training. We leave you with handouts, many available in multiple languages, and written instructions for self-care. The goal is to help you and your family learn to manage care on your own, when the nurse isn’t there.
- Adjustments to the care plan: Our home health team meets regularly to review your progress and adjust your care plan as needed. With our regular monitoring and thorough education, we help you avoid hospital visits and stay safe and independent at home.