Social Worker, MSW

Mô tả công việc

Job Summary:    The Social Worker, in collaboration with the interdisciplinary team (IDT), provides and facilitates acquisition of economic, social, and emotional support services to hospice patients and their families/caregivers.  The Social Worker’s responsibilities include, but are not limited to: psychosocial consultation to other agency personnel; collaboration  with other  IDT members; referrals to outside agencies; homemaker services; and direct services to hospice patients and their families/caregivers.    Essential Functions:   Service - Strives to meet or exceed expectation in the delivery of services, care and pain/symptom management; contributes to enhancing the quality of the work environment. Follows up and interacts with patients/families/caregivers and employees in a courteous and professional manner at all times to ensure that a 5-Diamond experience is received by all customers that will contribute to Hospice of Michigan’s status as a world class hospice. Completes arrangements as needed for patient/family/caregiver satisfaction in accordance with the plan of care. Performs advocacy and oversight of hospice services based on patient self-determination to assure patient and family/caregiver satisfaction. Assists patient and family/caregiver with placement arrangements. Assists patient and family/caregiver with making funeral arrangements and legal planning as needed. Assesses patient/family/caregiver social, emotional and financial factors in order to cope with the terminal illness and death. Assesses the patient/caregiver psychosocial status, potential for risk of suicide and/or abuse or neglect. Assesses environment resources and obstacles to maintaining safety. Assesses caregiver’s ability to function adequately. Identifies the developmental level of patient/family/caregiver and obstacles to learning or ability to participate in care of the patient. Develops, implements and revises the plan of care based on a thorough psychosocial assessment and consultation with team members, patient and caregivers. Evaluates patient for long-term care when appropriate and assesses ability to accept change in level of care. Communicates psychosocial information to inpatient facility when level of care is changed. Assesses and develops instructions and plan of care reflecting needs identified for homemaker assistance. Identifies patient/family/caregiver needs when discharged or when level of care changes; evaluates patient/family/caregiver response to intervention(s) when discharged or when level of care changes. Assesses the need for counseling related to risk assessment for pathological grief; provides counseling services to the patient/family/caregiver experiencing emotional, social and economic conflict; evaluates patient/family/caregiver response to psychosocial interventions.  Provides grief support and education to patients and their families/caregivers; helps to prepare the family/caregiver for future without the patient. Assesses special needs related to cultural diversity including communication, space, role of family members and special traditions. Documents patient care following established Hospice of Michigan (HOM) standards of documentation practice and regulatory and licensure requirements, and submits documentation in accordance with HOM policy. Practices within the NASW Code of Ethics. Participates in quality improvement initiatives. Consistently follows all departmental and organizational protocols and practices to ensure 5-Diamond service excellence is achieved with both internal and external customers, and that boundaries within the scope of practice are not exceeded. Adheres to HOM policies and procedures and all regulatory and legal requirements. Adheres to C.A.R.E. Model of Service: courtesy, acknowledgement, response and empathy. Teamwork - Effectively works with other members of a team, drawing on all resources to achieve a common goal or solve a problem.  Promotes teamwork as a way to generate positive and creative results. Works collaboratively with the IDT to provide patient and caregiver oriented hospice services. Completes assignments as directed by the clinical manager or HOM designee. Participates in IDT conferences by preparing to present cases prior to the conference and by being pro-active in problem solving and identifying creative solutions. As an IDT member, assists other team members in understanding the significant social and emotional factors related to care of terminally ill patients and their caregivers. Works collaboratively and actively participates in team functions and meetings. Participates as requested in the development of protocols and standards for hospice practice. Communicates complete and accurate information to all team members in a timely manner. Communicates all urgent initial care needs to the HOM call center at completion of each assessment. Acts as a resource for staff members and orients new staff as needed. Adheres to the HOM Code of Conduct and represents HOM in a positive and professional manner at all times.  Adheres to the Agreements of Belonging.  Stewardship - Manages resources such as time, expenses, supplies, labor, etc. well to ensure their prudent use; develops staff resources through training, mentoring, coaching, etc. Evaluates and monitors patient’s insurance coverage and options in assessing patient/ caregiver ability to meet financial obligations. Offers appropriate internal and community resources and assists patients, caregivers and staff in acquiring and utilizing resources, as indicated. Proactively problem solves and identifies solutions utilizing critical thinking skills. Participates in internal and external education and training, in-services and other activities to promote personal and professional growth. Responds to information requested by third-party payers. Utilizes allocated supplies and resources appropriately to ensure business outcomes are met. Adjusts to changes in workload and schedules based on changing departmental organizational priorities. Outreach - Educates the community about the services provided by HOM.  Actively promotes HOM’s mission with patients, families, communities and referral sources; offers care that fits the diverse needs of the community. Participates in the education & marketing of hospice services for referral sources and the community as requested. Participates in agency and community programs to promote professional growth and understanding of hospice care. Participates as requested in the development of HOM care delivery goals and strategic planning. Actively participates in activities that promote HOM’s mission in the community.