A Trusted Partner for Complex Transitions of Care
At Atascocita Seniors Care, we streamline the hospital-to-home discharge process for case managers, hospital social workers, discharge planners, and care coordinators. We specialize in accommodating residents with high clinical acuity, complex medical management needs, and ongoing personal care requirements in a warm, residential assisted-living setting.
Whether your patient is transitioning from an acute care bed, an LTACH, or an inpatient rehabilitation facility, our clinical intake team responds quickly to minimize readmission risks and ensure smooth, safe placement.
Referrals
Rapid Clinical Turnaround: Initial review of clinical records within 1–2 hours.
High-Acuity Capabilities: Equipped for complex care, including tracheostomies, PEG tubes, IV therapy, Wound VACs, and LVAD support.
On-Site Pre-Admission Assessment: Our intake nurse can conduct bedside or virtual pre-admission assessments directly at your facility.
Seamless Care Coordination: We collaborate closely with attending physicians, home health agencies, pharmacy partners, and hospice teams prior to admission.
High-Acuity Clinical Capabilities
We accept residents with diverse medical needs under our assisted-living licensure, subject to nursing assessment and physician orders:
Respiratory Care: Tracheostomy care, stable ventilator support, continuous oxygen management.
Vascular & Enteral Support: PEG/G-tube care, IV therapy, PICC/midline/central-line care.
Advanced Wound Care: Wound VAC systems, surgical wound management, pressure ulcer care.
Sub-Acute & Chronic Care: Diabetes management, surgical drain care, LVAD monitoring, mobility/transfer support.
Memory & Comfort Care: 24/7 dementia supervision, sub-acute rehabilitation step-down, hospice coordination.
How to Submit Clinicals & Referrals
We accept referral packets through multiple secure channels. Please include face sheets, history & physical (H&P), current medication administration records (MAR), physical/occupational therapy notes, and recent clinical progress notes.
Secure Referral Channels
Direct Referral Email:
[email protected](HIPAA-compliant secure email)Secure Intake Fax:
(513) 525-9016Direct Clinical Intake Line:
(513) 903-2890
Our 4-Step Referral & Admission Process
Clinical Packet Submission
Send patient clinicals via fax, secure email, or referral platform. Please include current physician orders, H&P, MAR, and relevant therapy notes.
Rapid Clinical Assessment
Our clinical nursing director reviews the packet and completes a bedside or virtual evaluation within 2 hours to confirm our facility can safely support the patient's care plan.
Verification & Orders
We coordinate directly with the attending physician for discharge orders, prescriptions, and specialized medical equipment delivery prior to arrival.
Smooth Transition & Admission
We finalize room placement and welcome the resident with a personalized care plan ready upon arrival.