Social Worker

The Hospice Social Worker is a member of the Interdisciplinary Team responsible for the co-case management of hospice patients and families. In collaboration with patient/family, physician and interdisciplinary team, develops and coordinates an individualized Plan of Care (POC) that reflects patient/family centered goals related to Safe & Comfortable Dying, Self-Determined Life Closure, and Effective Bereavement. Also addresses the multiple psychosocial issues that affect Hospice patients and their families/caregivers.

Essential Responsibilities

Patient and Family Care/Case Management

• Recognizes the patient and family as a "unit of care"
• Develops an individualized documented plan of care reflecting patient/family goals and provides social work services as outlined in the plan of care
• Identifies and monitors potential psychosocial hot spots.
• Provides co-case management support for issues related to care giving, advance directives, funeral planning, community resources and insurance benefit oversight
• Provides co-case management support for issues related to grief and loss, family dynamics and psychosocial history
• Collaborates with IDG regarding changes in patient status and POC
• Exercises professional expertise in managing and coordinating care between and among involved parties in home, SNF and RCFE setting
• Exercises good clinical judgment in the performance of all duties
• Understands and properly utilizes changing network of community resources
• Respects patient right to self-determination and acts as an advocate within the context of the vision, mission, values and ethical standards of HSCC.
• Assists Admission department with resourcing, assessment, information and registration process as requested
• Insures documentation is accurate, organized, legible, and a complete reflection of services provided as well as an interdisciplinary approach to care. Utilizes only approved abbreviations to ensure clarity of documentation
• Demonstrates the ability to articulate the parameters of hospice care and services
• Demonstrates the ability to work with patients/families under stress and in crisis
• Demonstrates understanding of Hospice Medicare/Medi-Cal Benefit and third party payors
• Demonstrates professional demeanor, tact, and respect in dealing with all patients, families, staff and volunteers
• Responds with flexibility to the changing needs within the assigned caseload
• Participates in rotation of weekend and holiday Social Work coverage as needed/requested
• Performs other related job duties as assigned by Supervisor

Requirements

Education

• Master of Social Work degree required from a school of social work accredited by the Council on Social Work Education.

Experience

• Minimum of 1 year of Social Work experience in a healthcare setting required
• Prefer previous experience in hospice or other end-of-life care and services
• Solid experience and/or aptitude with computer systems and electronic medical record systems and charting

Skills Desired

• Strong verbal and written communication skills
• Skilled in tact and diplomacy
• Capable of bringing appropriate level of sensitivity and compassion to patients/families facing terminal illness, death and bereavement
• Understands how to hold and apply appropriate boundaries for care
• Knowledge of community social work services, resources and operational standards
• Understanding of all applicable laws and regulations related to social work licensing
• Understands and utilizes solid ethics in decision making and activities
• Bilingual in English/Spanish highly desirable

Certifications, Licenses, Registrations

• LCSW or related license desirable but not required