The Rehabilitation Team
Castlemaine Health’s Rehabilitation Team includes a Medical Officer, Nursing staff, Physiotherapists, Occupational Therapists, Social Work,Speech Pathologist, Dietitican, and Pharmacist, Ward Clerk and Environmental Services.
We also access through internal referral : ACAS, Diabetes Educator, Mental Health, Pastoral Care,Continence Clinic, and Podiatry if required.
Each patient is assessed by a team of staff including Medical, Nursing and Allied Health professionals.
A plan is developed for a suitable program to meet the desired patient goals.The patient is reviewed and the plan evaluated bi weekly at team meetings or more often if required. Reassessment and goal revision are constant throughout the Rehabilitation program.
Discharge Planning commences on admission.
Services and assistance will be identified by patient, treating team, family/carers or a case manager to ensure a smooth transition home. Family meetings may also be undertaken to further identify service needs and discharge destinations. Some patients may require facility care and the Aged Care Assessment Team will undertake assessments of the patient with their recommendation.
Referrals for Discharge.
If required, rehabilitation is continued on an outpatient basis through the Community Rehabilitation Centre at Castlemaine Health. Referral to this service is discussed as part of the discharge plan, to provide post-discharge support. Referrals can also be made to District Nursing, Mount Alexander Shire home services, specialist clinics, Post-Acute Care, Respite, Restorative Care, Transitional Care program or Aged Care Assessment Services.