Services > Memory & Brain Health
Post-Hospital & Transitional Care for Older Adults
The days after a hospital stay, a new diagnosis, or a sudden change can feel overwhelming. We help you and your family understand what happened and plan confidently for what comes next.
Is This Right For You?
The weeks after a hospital stay are a vulnerable time for older adults. Care Transitions & Post-Acute Care Support may be right for you if:
Our goal is to diagnose people with cognitive changes as early as possible so that we can intervene to slow down memory loss.
You or a loved one recently left the hospital
Coming home from a hospital stay, rehabilitation, or a skilled nursing facility.
Medications changed during the stay
New prescriptions, stopped medications, or confusion about what to take now.
Something has changed
A new diagnosis, new weakness or confusion, or a sudden decline in function.
Hospital visits keep happening
Repeated emergency department visits or readmissions you would like to avoid.
Your family feels overwhelmed
Unclear discharge instructions and too many questions about what comes next.
“
After being hospitalized, my husband came home on several new medications and wasn’t doing well. Dr. Prather did a thorough medication review and was able to change or stop some medications that weren’t helping him.
— MICHELLE N.
What Is a Transition Visit?
A Transition Visit is a prompt geriatric visit after a hospital or rehabilitation stay, in our office, by telehealth, or at home for a travel fee. It is designed for the moment when families most need someone to explain what happened and help them plan.
We review the hospital course and discharge plan, reconcile new and changed medications, look at safety and function at home, and make sure you know what to watch for and what comes next.
Your Transition Visit includes one visit of up to 2 hours, which can take place in your home for a travel fee. We will review pertinent health records, perform a comprehensive medication review, help you make sense of your changing health, and recommend a plan to help get your health back on track.
WHAT’S INCLUDED
One-time 2-hour visit
Review of the hospital stay and discharge plan
Medication reconciliation and review
Safety, mobility, and function at home
What to watch for, and when to call
Time for your family’s questions
WHAT YOU’LL RECEIVE
A written care summary with clear recommendations
A confident plan for the weeks ahead
A recommended membership for ongoing support
Starting at $1200
one-time assessment fee
Your exact fee is confirmed before your visit. Paid directly to the practice.
What You Can Expect
Fewer, better medications
Every medication is reviewed to make sure it is still helping.
Protect your independence
A plan to support strength, mobility, and safety at home.
A written care summary
Recommendations you and your other doctors can follow.
A geriatrician in your corner
Ongoing guidance as your health and goals evolve.
Starting Care Together
Three simple steps, and you never have to figure out the next one on your own.
Schedule an Introductory Call
A short, no-pressure conversation with you or your family to hear what is happening and see whether we are the right fit. Based on what you need, we’ll recommend the best initial assessment for you.
Get a Clear Plan
We schedule an unhurried assessment—focused on memory, palliative care needs, or aging well—ending with a written care plan that is easy to follow.
Ongoing Care, With Support
We recommend the membership plan that fits your needs, with ongoing care and direct access, so you are never facing the next change alone.
You Don’t Have to Navigate This Alone
Noticing changes in memory or thinking, in yourself or someone you love, can bring fear, uncertainty, and a long list of questions. Those feelings are understandable, and you deserve a physician who slows down, listens, and helps you find a way forward.
Dr. Christina Prather is a geriatrician, fellowship trained in both Geriatric Medicine and Hospice and Palliative Medicine. She takes time to hear your whole story, explains what is happening in plain language, and helps you and your family make a plan you can feel confident about.
“There are moments in health when you or your family just need more support. That’s exactly what Prather Medicine is here for.”
— DR. CHRISTINA PRATHER
Connect with Care
Schedule a complimentary 15-minute introductory call to learn if Prather Medicine is the right fit. There is no obligation.
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