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Continuum of Care Department


(212) 312-5838


Scope of Service

The Continuum of Care Department is an integral component of the comprehensive interdisciplinary care provided to New York Downtown Hospital patients and families. Its primary responsibility is facilitating coordination and communication between all members of the healthcare team to optimize quality outcomes during hospitalization and after discharge. A nurse Case Manager and Social Worker are assigned to each unit.

Clinical Services

The Case Manager, who is a registered nurse, facilitates communication and coordination between all members of the health care team. This coordination involves the patient, family and physician. The nurse Case Manager is the link between the patient, the providers, the payor (insurance company) and community.

The Social Worker assists the patient and family in coping with the social and psychological problems that result from illness. The Social Worker provides support, counseling, crisis intervention and referrals to community agencies. The Social Workers also work with the families to select appropriate nursing homes or rehab facilities for discharge.


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