The complex rehabilitation unit is supported by the Trust’s social work team
Their work includes:
- Working to achieve a safe discharge plan that is considered the best outcome for the patient
- Taking into consideration patient views and wishes.
- Balancing complex family dynamics often at point of crisis
- Advocating best interests and wishes of the patient then using this to implement a clear discharge plan
- Assisting with benefits and financial queries
- Carry out capacity assessments and work with the team to implement a clear discharge from hospital
Referral process
If the ward feels a patient requires an Adult Social Care assessment they will make a referral to the Adult Social Care Team. We will then allocate the case to one of our two workers and aim to see that person within 2 days.
Assessment period
Whilst you are in hospital one of our team will assist you or signpost you to relevant organizations and support. As we are a hospital based team who only assist with discharges, once you leave hospital your case will either be closed if no further support is required or reallocated to a new social worker in the community who will then carry on supporting you.