Provides care to adult patients with recent change in health status requiring intermittent skilled home health services. Services include patient/family education and training of self-care provided by registered nurses, physical therapists, occupational therapists, speech therapists, home health aides, and medical social workers. Registered Nurses assist with discharge planning and perform an in-home evaluation and examination to determine patient needs. This service includes development of care plans, treatment, planning, medication management and coordination of communication between client, health care professionals and community services. Specialty services include: certified ostomy nurse, certified wound nurse, certified diabetic educators, mental health nurses, infusion nurses, and Advanced Illness Management (AIM) program.