Headwaters Health Care Centre (Headwaters) is pleased to announce its partnership with Bayshore HealthCare Integrated Care Solutions (Bayshore) to extend patient health care beyond the hospital walls through the Headwaters2Home program.

Designed to assist older adults in transitioning safely back home after hospital stays, the Headwaters2Home program offers up to 16 weeks of comprehensive care delivered directly to patients’ homes by an integrated Bayshore team, with support from a Headwaters program coordinator.

Since its launch in December 2023, the program has successfully served over 50 patients referred by Headwaters. Eligible patients and their families engage with Headwaters staff to explore program enrollment, discuss expectations, and collaboratively develop personalized care plans in consultation with Bayshore professionals. This approach ensures a smooth transition from hospital to home, optimizing the patient experience.

Tom Porter, a former patient at Headwaters, was enrolled into the program following a fall at home due to complications from arthritis, a herniated disc, and urological issues. After a brief hospital stay, he received nursing care, laboratory services, and physiotherapy at home from Bayshore staff as part of the Headwaters2Home program. His family physician is also a part of his care team.

The Headwaters2Home program benefits patients and their families by enabling recovery at home. It also aids Headwaters in managing patient capacity and flow. The program addresses hospital capacity issues by allowing patients, particularly seniors transitioning to alternate levels of care (ALC), to receive necessary care at home post-discharge.

The program also offers 24/7 telephone support and conducts ongoing assessments for enrolled patients over a 16-week period. If patients need care beyond this period, additional assessments determine their eligibility for continued support.