The role of social work with vulnerable adults has changed markedly in many countries, including England and Wales following the 1990 NHS and Community Care Act. The basis for this paper is a small qualitative study of the social work role in helping people entering residential or nursing care in the independent sector following an emergency hospital admission in England (Phillips and Waterson 1997). This double transition is an under-researched area (Bywaters 1993; Downs and Crossan 1999).