WHAT IS CHRONIC DISEASE MANAGEMENT
Chronic disease management is physician-directed skilled care designed to help patients safely manage long-term medical conditions while reducing complications and avoidable hospitalizations.
Our interdisciplenary team provides:
- Skilled Nursing
- Medication Management
- Disease Education
- Vital Sign Monitoring
- Therapy Services
- Respiratory Support
- Nutrition & Hydration Guidance
- Ongoing Physician Coordination
CONDITIONS WE COMMOMLY MANAGE
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Congestive Heart Failure (CHF)
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COPD
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Diabetes
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Hypertension
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Coronary Artery Disease
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Pheumonia Recovery
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Kidney Disease
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Arthritis
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Parkinson’s Disease
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Stroke Recovery
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Dementia/ Alzheimer’s
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Complex Post- Hospital Recovery
SIGNS YOU MAY NEED HOME HEALTH SUPPORT
- You were recently hospitalized
- You’ve had repeated ER visits
- You struggle managing medications
- You feel weak after illness
- You have shortness of breath
- You have uncontrolled blood sugar
- You’ve experienced falls
- Your physician recommended home health
- Leaving home is difficult
COMPREHENSIVE CHRONIC DISEASE SERVICES
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Medication Management
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Vital Sign Monitoring
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CHF Monitoring
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COPD Management
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Diabetes Education
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Oxygen Safety
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Respiratory Monitoring
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Fall Prevention
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Dietary Education
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Weight Monitoring
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Therapy Services
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Caregiver Education
HELPING PATIENTS STAY SAFELY AT HOME
Our team focuses on preventing complications and avoiding unnecessary hospital readmissions
- Early symptom detection
- Medication compliance
- Ongoing nurse assessments
- Physician communication
- Education for patients & fanilies
- Rapid response to condition changes
- Nutrition & Hydration Guidance
- Preventing avoidable ER visits
DISEASE-SPECIFIC MONITORING & MANAGEMENT
CHF MONITORING
- Daily Weight Monitoring
- Swelling Assessment
- Shortness of Breath Monitoring
- Fluid Management Education
COPD MANAGEMENT
- Oxygen
- Breathing Assessment
- Inhaler Education
- Energy Conservation Training
DIABETES MANAGEMENT
- Blood Sugar Education
- Foot Monitoring
- Nutrition Guidance
- Medication Teaching
THE HOMESTEAD CHRONIC CARE JOURNEY
PHYSICIAN REFERRAL
Your physician sends us referral.
CLINICAL WOUND ASSESSMENT
We perform a comprehensive wound evaluation.
CUSTOMIZED HEALING PLAN
We create a plan tailored to your wound and goals.
WEEKLY PROGRESS MONITORING
We track progress and adjust the plan for optimal healing.
WHY HOSPITALS CHOOSE HOMESTEAD
- CMS S-Star Rated
- Reduced Hospital Readmissions
- Same-Day Admissions
- Weekend Admissions
- Chronic Disease Specialists
- Strong Physician Communication
- Interdisciplenary Team Approach
FOR REFERRAL PARTNERS
We partner with hospitals, primary care providers, specialist, rehab centers, and senior communities to deliver exceptional chronic care outcomes.
- Hospitals
- Physicians
- Specialist
- Service Communities
FOR REFERRAL PARTNERS
Fast, Reliable &
Easy Referrals
We partner with hospitals, physicians, rehah centers, and senior communities to ensure a smooth transition and excellent outcomes.
Same-Day Response
Clinical Coordination
Reliable Communication
Smooth Transitions
SUBMIT A REFERRAL IN MINUTES
FREQUENTLY ASKED QUESTIONS
Does Medicare cover chronic disease management at home?
Yes, Medicare may cover chronic disease management at home when services are medically necessary, ordered by a physician, and provided by a Medicare-certified home health agency.
Can home health help prevent hospitalizations?
Yes, home health care can help prevent hospitalizations by providing skilled nursing, ongoing monitoring, medication management, and early intervention to address health concerns before they worsen.
Can nurses help manage COPD
Yes, Homestead’s skilled nurses help manage COPD by monitoring symptoms, providing education, managing medications, and coordinating care to support better breathing and reduce complications.
Can home health help with diabetes?
Yes, Homestead’s home health team helps manage diabetes through blood sugar monitoring, medication education, foot care guidance, and personalized support to promote better health and prevent complications.
Can home health monitor CHF symptoms?
Yes, Homestead’s skilled nurses monitor CHF symptoms, track changes in your condition, and provide education and support to help prevent complications and hospitalizations.
Do you admit on weekends?
Yes, Homestead admits patients on weekends to help ensure timely access to the home health care you need.
Need Advanced Wound Care Today?
Our team is ready to help you heal safely at home. Same-day and weekend admssions available.