Recently Discharged Patients
This service is designed for seniors and homebound patients who have recently been discharged from a hospital, rehabilitation facility, or skilled nursing facility. It is especially valuable for patients with complex medical needs, multiple chronic conditions, or those at higher risk of hospital readmission. We step in during your transitional care period until you are able to return to your regular doctor — providing another set of eyes to clinically address your health and recovery needs during this stressful time.
Your Recovery, Step by Step
Home Visit Within 48 Hours
A Mulberry Health provider will see you often within 48 hours of discharge for a comprehensive assessment, medication review to ensure nothing slipped through the cracks, and a personalized recovery plan.
Ongoing Clinical Monitoring
Follow-up visits are scheduled weekly or more frequently as needed to monitor vitals, manage medications, assess wounds, and adjust your recovery plan.
Safe, Full Recovery
Our team coordinates with your hospital care team and specialists, providing family education and rapid response for any changes in condition — keeping you out of the hospital.
Your Care, Your Choice
Once your recovery is complete, you can return to your regular physician or continue with your Mulberry Health provider for ongoing primary care needs — from the comfort of your own home.
Why Post-Acute Care Matters
Reduced Readmission Risk
Expert clinical oversight during the most critical recovery window significantly lowers the risk of returning to the hospital.
Medication Reconciliation
We review and manage all medications post-discharge to prevent errors, interactions, and complications — ensuring nothing has slipped through the cracks.
Post-Surgical Wound Care
Our providers monitor and assess surgical wounds at every visit, ensuring proper healing and early intervention if needed.
Coordinated Continuity
Seamless coordination with hospital discharge planners, specialists, and primary care providers for uninterrupted care.
Family & Caregiver Support
Education, guidance, and support for family members and caregivers throughout the recovery process.
Rapid Response
If your condition changes, our team responds quickly — adjusting treatment plans and escalating care when necessary.
Services Our Team Coordinates
Mobile Blood Draws & Lab Services
Mobile Imaging ServicesX-ray, EKG, Ultrasound
Ordering Durable Medical Equipment
Home Health & Skilled Nursing Referrals
Physical & Occupational Therapy Coordination
Specialist Referrals
Begin Your Recovery at Home
Register today and our care team will visit within 48 hours of your discharge.