A structured, clinician-led approach to safe recovery in the move from hospital to home.
For those returning home after a hospital or ICU admission.
For people recovering from major surgery who need supervised care.
For those managing complex medication routines that need supervision.
People needing wound care and close monitoring at home.
For those with reduced mobility needing safe daily support.
For those managing complex medication routines that need supervision.
Your care combines clinical expertise, therapy and ongoing support, all working towards the abilities and independence you want to rebuild.
A careful review of your hospital discharge plan and instructions.
Skilled nursing care and close daily monitoring at home.
Organising and supervising medicines to keep recovery on track.
Wound care, dressings and monitoring throughout your recovery.
Setting up your home for safe, confident recovery.
Coordination between your doctors, our team and family.
HOW WE WORK
Your plan is led and reviewed by senior clinicians, and your therapists, nurses and doctors work to the same plan rather than in separate departments. We review progress regularly and change the plan as you change.
Transition care is a structured, clinician-led programme that bridges the gap between hospital discharge and safe recovery at home. It is designed for patients returning home after a hospital or ICU stay, those recovering from major surgery, and anyone with complex medications, wounds, or reduced mobility who needs supervised support before managing independently.
If a hospital advises discharge but the patient still needs medical monitoring, wound care, medication supervision, or help with mobility, transition care offers a safer next step than going straight home. The team reviews the hospital’s discharge instructions and takes over supervised care, giving both the patient and family time to adjust safely.
Transition care is designed for patients who are medically stable enough to leave hospital or ICU but are not yet ready for fully independent recovery at home, bridging the gap between discharge and safe home recovery. The clinical team reviews the hospital’s discharge summary and coordinates with the discharging team to plan a safe handover; whether a specific patient can be accepted is confirmed during this assessment.
Yes, tracheostomy care and support with weaning can generally be supported as part of transition care, subject to confirming the plan is right for the patient’s specific clinical needs and stability. Discuss the details with the Dexterity team so they can confirm the scope of support for your case.
Transition care includes skilled nursing care and daily monitoring that supports patients with reduced mobility, including many bedbound or minimally responsive patients. Because the level of nursing and medical support needed varies significantly case by case, the clinical team confirms during the initial assessment whether a specific patient’s needs can be met.
Transition care combines both skilled nursing support and active clinical oversight rather than nursing alone. Along with daily monitoring, medication management and wound care, the doctors, nurses and therapists work from a shared care plan, so therapy can be included where the patient’s condition calls for it.
Recovery after a hospital stay takes time and differs from person to person. We give you a clear plan, skilled care and an honest view of progress at every stage.
