Social Worker

• To assume a caseload as assigned.
• To greet and help acclimate new residents.

§ To assess and identify residents’ personal and social problems, and needs which interfere with the optimal benefit of their health care plan and overall quality of life.

§ To provide direct services, by casework or group work, to those residents and/or relatives evidencing emotional problems in the area of medical, personal and interpersonal concerns.

§ To engage in advocacy on behalf of the individual with the facility, staff, and/or the community; to contribute to the increasing knowledge and understanding of staff and the community regarding the uniqueness of the older individual, and to insure the maximizing of the principles of individual integrity and continuity of care.

§ To maintain effective contact with all members of the staff, providing collaboration and consultation as indicated, using social work knowledge of communication skills, problem-identification, the process of mutual problem-solving, and the use of group dynamics skills for the maximum benefit of the individual.

§ To maintain ongoing contact with families to provide support and (with resident permission) to report on changes in health, current goals, discharge planning and to encourage their participation in care planning.

§ To initiate and participate in interdisciplinary meetings and team conferences.

Through MDS assessment and care planning process, to seek and identify ways to support residents’ individual needs and preferences, customary routine, concerns and choices.

§ To direct and/or establish social work goals with the resident consistent with the overall plan of care.

§ To establish and maintain appropriate case records, of an interdisciplinary nature when appropriate, in accordance with State and Federal standards.

§ To participate in the admission and discharge services of the Social Services Department as needed.

§ To coordinate and facilitate room transfer of residents for a satisfactory placement of the resident within the facility.

§ To provide indirect social services to the benefit of the resident which shall include but not be limited to applying for pensions, referrals to lawyers, referrals to funeral homes for preplanning arrangements, etc.

§ To provide crisis intervention with residents and/or families.

§ To provide or arrange the provision of needed counseling services (e.g. psychosocial issues, financial, bereavement).

§ To provide administrative liaison between the resident and the various governmental assistance programs, especially Medicare, Medicaid and other third party payers.