Introduction

Care transitions across settings (hospital, institutional settings, and home) are vulnerable exchange points for patients and family caregivers that contribute to higher risk of poor health outcomes. For older adults and individuals with behavioral health concerns, including those with dementia and cognitive disturbance, substance use disorder, and primary psychiatric diagnoses, care transitions are even more challenging, resulting in unmet patient and caregiver needs, increased safety risks, high rates of preventable readmissions, and increased healthcare costs.

Improvement of transitional care remains a complex endeavor requiring attention to the perspectives of the multiple stakeholders engaged in care transitions and the practice of cultural humility.

Participants in this conference will hear from national and state experts regarding the current challenges involved in coordination of care across the health care continuum for individuals with mental health concerns and learn ways to improve communication between health care providers during patient transitions. A focus on person-centered care during transitions between care settings today and in the future will be addressed.

Who Should Attend?

Physicians, physician assistants, nurses, social workers, case managers, nursing home administrators and staff, chaplains, and others interested in successfully facilitating transitions of care and improving patient outcomes.