Overseeing hospital discharges under the Discharge to Assess Framework / Care Act.
To work as a Social Worker as part of a multi-disciplinary team. To provide support to older people with diagnosed memory problems who need social care because of their mental health and/or memory problems.
To work in collaboration with colleagues from health and social care to respond to urgent requests for assessment/monitoring/support to people with a diagnosis of dementia or significant mental health disorder who are presenting with a physical health problem to prevent hospital admission and to facilitate a co-ordinated discharge back into community.
To work in collaboration with the intermediate care team to facilitate reablement when identified.
The team works closely with colleagues in the NHS to ensure that needs are met holistically and, in the ways, most appropriate to the person and their family carers.
The role is to coordinate the identification of those needs and develop support plans to meet those needs within the personal budget available, maximising choice, control and independence.
To ensure that the social care needs of people are met, within the eligibility criteria of the department, by working in partnership with people who use the service, their carers, professionals and other agencies, and service providers.
To support in delivering and maintaining high standards of performance ensuring continuous development and supporting people to fulfil their roles to maximum effectiveness within allocated resources.