In partnership with St. Joseph’s Continuing Care (Cornwall), the Pembroke Regional Hospital is pleased to announce the launch of a new Remote Care Monitoring (RCM) program that is designed to support frail seniors as they transition from hospital to home.
Supported locally by the Ottawa Valley Ontario Health Team (OHT) and regionally by Ontario Health East, this innovative 30-60 day program offers personalized virtual care and support for patients aged 55 and older who have recently been discharged from hospital or visited the Emergency Department and may be at risk of hospital readmission.
This could include those with new or adjusted medications, mild cognitive impairment, health anxiety or chronic conditions, those at high risk for falls or post-rehabilitation patients requiring followup.
Free of charge for those who are referred by PRH Clinical Care Leads, Geriatric Emergency Medicine nurses or our Mobile Geriatric Day Hospital staff, the program is designed to complement, not replace, existing primary care, with the Remote Care Monitoring team working closely with family physicians and other community partners to ensure seamless care coordination.
“This initiative is a game-changer for our patients,” said PRH President and CEO Sabine Mersmann. “It bridges the gap between hospital and home, ensuring that our most vulnerable seniors receive the care and guidance they need during a critical time in their recovery. By helping our seniors remain healthy at home and connecting them to community supports, we’re not only improving outcomes – we’re enhancing lives.”
As part of the program, patients receive a care package direct to their home which includes a tablet, blood pressure cuff, oxygen monitor, weight scale, and other tools to monitor their health, as well as telephone support for both patients and caregivers to ensure comfort and confidence in using the technology.
Then, after working together with a nurse to develop a care plan and goals, with daily symptom tracking, weekly nurse check-ins, medication management support, tailored health teaching and daily vitals monitoring, the program empowers patients to manage their conditions safely and confidently from the comfort of their own homes.
“Connecting patients to vital community services, easing the burden on caregivers, and ensuring a smooth transition from hospital to home are all part of our commitment to compassionate, coordinated care,” Mrs. Mersmann said, noting that, as the Ottawa Valley OHT continues to prioritize integrated, patient-centered care, the RCM program represents a meaningful step forward in supporting seniors and their families.
(Richard Evans)
