The MSW provides supervision to social work team along with providing services to home health and hospice patients and their families. The individual performs psychological and psychosocial assessments and planning; and implements and evaluates care. S/he is an active participant in the Hospice IDT.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Provides supervison to social work team including collaborating as needed regarding home health and hospice patient and caregiver situations.
• Communicates regularly with BSW or social worker assistants who are providing follow-up care on home health and hospice patients
• Completes psychosocial evaluation/assessment visit on each assigned hospice patient and caregiver including history within 5 days of admission.
• Makes pre-admission hospice visits as assigned. Assesses appropriateness for hospice care, gives information on Hospice Medicare/Medicaid Benefit and/or other insurance benefits, if any.
• Assesses the concerns of home health or hospice patient/caregiver on an ongoing basis.
• Assists the home health or hospice patient/caregiver in identifying goals and establishing priorities on an ongoing basis.
• Assists the home health or hospice patient/caregiver in assessing financial needs and determines eligibility and availability of appropriate community resources.
• Participates in developing the hospice bereavement plan of care through the IDT.
• Is a member of hospice Quality Improvement Committee and completes assessments as assigned.
• Participates in development of initial hospice care plan in conjunction with IDT specific to the needs of each patient/caregiver within 24 hours of admission.
• Ensures pertinent patient information is communicated to the home health or hospice case manager and/or other members of the care team as necessary.
• Assists the home health or hospice patient/caregiver in planning for transfer from one setting to another (i.e., home to nursing home) and facilitates implementation as requested.
• Assists in planning transition of patient and caregiver if discharge or revocation from the hospice program occurs.
• Works under the supervision of the MSW, collaborating as needed regarding patient and caregiver situations.
• Establishes and implements the hospice psychosocial care plan within 5 days of admission, and institutes appropriate revisions on an ongoing basis.
• Provides home health or hospice social work services to assigned patients per plan of treatment
• Assists in facilitating effective adaptation to the crisis of illness and impending death.
• Communicates with physician and other team members as needed regarding changes in patient/caregiver status.
• Makes referrals to other appropriate health care workers and/or agencies as necessary.
• Advises other team members regarding psychosocial needs for specific patient/caregiver situations as appropriate.
• Facilitates patient/caregiver conferences to assist them in making decisions and effectively communicate.
• Participates in hospice IDT meetings a minimum of every 14 days. Contributes to care plan revisions of all patients reviewed based on knowledge and experience.
• Participates in home health care conferences or palliative care team meetings as requested.
• Evaluates volunteer services informally and provides input to Volunteer Coordinator, hospice team or palliative care team as appropriate.
• Is a member of the hospice Quality Improvement Committee and completes assessments as assigned.
• Other duties as assigned

QUALIFICATIONSAdoray expects employees to understand and to incorporate the values of our organization in their day-to-day practice. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Requirements

• Master of Social Work (MSW) degree from an institution accredited by the Council on Social Work Education.
• One year of social work experience in a health care setting required, two years preferred.
• Hospice and/or home health experience preferred.
• Strong leadership skills.
• Training or experience in bereavement or grief preferred, including assessment skills.
• Understanding and commitment to hospice concept and philosophy
• Excellent communication skills.
• Knowledge of community resources.
• Knowledge of hospice philosophy.
• Ability to work autonomously and make independent judgments.