Social Services & Discharge Planning

Social Services, Care Planning and Discharge Support

At Silver Springs Care Center, our Social Services team supports residents and families throughout every stage of their experience—from admission and adjustment to ongoing care planning and, whenever possible, a successful transition back home and into the community.

Whether a stay is for short-term rehabilitation or long-term care, our social workers serve as a resource for residents and families as they navigate changes in health, independence, living arrangements and care needs.

Support Beginning at Admission

Transitioning from a hospital or home into a skilled nursing center can be a significant change for both residents and their families.

Our Social Services team helps make that transition as comfortable as possible by getting to know each resident, understanding their individual circumstances and helping residents and families become familiar with their new environment and plan of care.

Social workers collaborate with nursing, rehabilitation, recreation, dietary services and other members of the interdisciplinary care team to help ensure each resident’s needs, preferences and goals are understood.

Individualized Care Planning

Residents and families are important members of the care planning process.

Throughout a resident’s stay, Social Services participates in interdisciplinary care planning and helps facilitate communication among residents, families and members of the care team.

Depending on the resident’s individual needs, Social Services may assist with:

• Care planning and resident goals

• Adjustment to short-term or long-term care

• Resident and family communication

• Psychosocial and emotional support

• Advance care planning

• Identification of community resources

• Coordination with outside agencies and providers

• Discharge and transition planning

• Resident advocacy and support

Our goal is to help residents remain informed, involved and connected throughout their care.

Planning for a Successful Return Home

For short-term rehabilitation residents, planning for discharge begins well before the day they leave Silver Springs.

Social Services works closely with nursing, rehabilitation, residents and families to identify what may be needed for a safe and successful transition to the next setting of care.

Depending on individual circumstances, discharge planning may include coordination of:

• Home healthcare services

• Outpatient therapy

• Medical equipment

• Follow-up appointments

• Community-based services and resources

• Transportation needs

• Medication and care information

• Family and caregiver education

• Other services recommended by the interdisciplinary care team

Whenever possible, the goal is to help residents safely return to their homes and communities with the appropriate services and supports in place.

Supporting Long-Term Care Residents and Families

For residents who make Silver Springs their long-term home, Social Services continues to provide support throughout their stay.

Our social workers assist residents and families as needs and circumstances change, helping residents adjust to their environment, maintain meaningful connections and participate in decisions about their care.

The team also serves as an ongoing resource for families navigating the medical, emotional and practical changes that can accompany long-term care.

Connecting Residents with Resources

Healthcare can be complicated, particularly when an individual is moving between a hospital, skilled nursing center and home.

Our Social Services team helps residents and families understand available resources and connect with appropriate services and organizations based on their individual circumstances.

We also collaborate with hospitals, healthcare providers, community organizations and agencies to promote continuity of care throughout these transitions.

Social Services at Silver Springs Care Center

At Silver Springs, Social Services is an integral part of the interdisciplinary care team.

By combining care planning, resident advocacy, family support and thoughtful discharge coordination, our goal is to make each transition in care as organized and successful as possible while keeping the resident’s individual needs and goals at the center of the process.

Learn More About Silver Springs

If you are considering short-term rehabilitation, skilled nursing or long-term care for yourself or a loved one, contact Silver Springs Care Center to learn more about our services and admissions process.

Silver Springs Care Center
33 Roy Street
Meriden, CT 06450

Main Number: (203) 237-8457