Torrance Memorial Medical Center has been recognized by the California Association of Health Facilities (CAHF) for developing an innovative program to coordinate patient care among eight local nursing homes – and reduce unnecessary return visits to hospitals.
Through regular meetings among key staff at all eight skilled-nursing facilities (SNFs), the Post Acute Network at Torrance Memorial's 40-bed Transitional Care Unit encourages traditionally competitive "SNFs" to improve communications and collaborate on ensuring high-quality care.
"The program bridges the gap between 'acute care' at hospitals and 'post-acute care' at nursing facilities, working to rehabilitate patients and return as many as possible to their own homes," said Josh Luke, Ph.D., FACHE, Vice President, Post Acute Services, Torrance Memorial Medical Center. "Traditionally-competitive nursing homes have now joined together with the local hospital to improve quality of care in the community."
The Torrance Memorial Transitional Care Unit was one of only six organizations statewide to receive an Excellence in Programming Award from CAHF during the association's annual convention in November.
The TCU's role at Torrance Memorial is to optimize the patient's quality of life and to help the patient transition out of the hospital. Patients may go directly home from the TCU or transition again to another level of care for continuing support, such as an acute rehabilitation unit, a lower level skilled unit, a custodial care situation or hospice care. The team assesses each patient and sets goals for discharge upon arrival into the unit. The care teams at the Torrance Memorial TCU include physicians, nurses, therapists, social workers, activities specialists, nurse assistants, nutrition specialists, and others who will work with patients to devise a plan while in the TCU and for the next step in their continuing care. In 2013, the Torrance Memorial TCU was recognized with an overall quality rating of five stars (the highest possible) from the federal Centers for Medicare and Medicaid Services (CMS), putting it among the top 10 percent of nursing homes nationwide. The Overall Quality rating is based on performance measured in four categories: Health Inspections, Quality Measures, Staffing and Registered Nurse (RN) Staffing.
Total Wellness Torrance Post Acute Network is made up of Torrance Memorial Medical Center Transitional Care Unit, as well as seven privately-owned free-standing skilled nursing facilities that are unaffiliated with Torrance Memorial Medical Center and Torrance Memorial Health System. These seven independent skilled nursing facilities include: Bay Creast Care Center, Del Amo Gardens Covalescent, Driftwood Healthcare Center, The Earlwood Care Center, Lomita Care Center, Royalwood Care Center and Sunnyside Nursing Center.