Transition Support Programs Assist Patients and Families in the Return to Home

The transition back home following rehabilitation is a major step—for both the patient and their caregivers. At Shepherd Center, the Transition Support Program prevents rehospitalization, improves health and safety outcomes and promotes patient and family autonomy once the patient is discharged from Shepherd Center.

Laura O’Pry, RN, BSN, CCM, CRRN, manager for the Transition Support Program, joins Picking Our Brain with Shepherd Center for a new podcast episode discussing the support and resources available to patients, their families and caregivers after rehabilitation.

Download the podcast as an audio file above, or access it at shepherd.org/podcasts.

“Once our patients come to Shepherd, they can receive weeks to months of really intensive rehab. And of course, once they go home, we want to keep them at home,” O’Pry says. “We want to keep them safe, so we do everything we can possibly do to prevent them from ending back up in the hospital.”

O’Pry has more than 13 years of experience working in both brain and spinal cord injury rehabilitation. She continues to work both in the inpatient and outpatient settings, while assisting patients with community re-entry. Her current position includes supervision of transitional support case management, life skills training, peer support programs and vocational rehabilitation services. These departments work together collectively to maximize client and family independence and autonomy by providing education, guidance and support upon discharge home to improve health and safety outcomes, ultimately preventing unnecessary rehospitalization.