Transitional Care: Methods and Processes for Transitioning Older Adults With Cancer in a Postacute Setting.

BACKGROUND: The concept of transitional care and the methods and processes to efficiently and effectively transition patients between a variety of care settings remains a continuous healthcare goal. Despite the numerous transitional care models that have been developed and implemented in a myriad of healthcare settings, increasing healthcare costs and substandard patient outcomes persist.

OBJECTIVES: This article will examine the topic of older adults with cancer when transitioned to a skilled nursing setting and the challenges they may face along the care continuum. In addition, it will look at the continuity of care between the hospital and skilled nursing facility, as well as explore some of the clinical difficulties experienced by older adult patients with cancer in the postacute care setting.

METHODS: Keyword searches were conducted in a selected literature review of CINAHL®, Ovid, PubMed, and Google Scholar databases.

FINDINGS: Successful transitional care models are built around effective communication and often include an interprofessional team approach and/or a nurse navigator to aid in the effective execution of medical treatment and patient care plans.