Social Worker
Description Job Duties (include, but are not limited to the following): Assists the physician and other team members in understanding the significant social and emotional factors related to the patient’s health problems. Assesses psychosocial situation of patient/caregivers referred to the home health agency. Assists them to understand and follow the medical recommendations made by the home health team in order to restore the patient to the optimum social and health adjustment within the patient’s capacity.
Carries out social evaluations and participates in the development of the plan of care. Provides information and referral services for Agency patients and families regarding practical and environmental needs. Provides information to patients and families on financial assistance programs and resources. Assists the patient and family with personal and environmental difficulties which pre-dispose toward illness or interfere with obtaining maximum benefits from medical care.
Serves as liaison between patients or families and community agencies. Maintains collaborative relationships with Home Health Agency staff to support patient care. Maintains and develops contact with public and private agencies as resources for patients and staff. Uses state hotline appropriately in crisis situations. Works with patient families as needed to provide the best care for the patient. Utilizes appropriate community resources.
Participates in discharge planning. Participates in education programs. Acts as a consultant to home health care staff inter-disciplinary team members. Confers with the family, referring physician, and other agency professional staff to obtain information to promote coordinated, efficient, and quality patient care. Performs and submits required documentation of patient’s evaluations, plan of care, clinical notes, and progress reports, summaries along with changes in orders.
All patient visit notes must be turned in the next scheduled work day, not to exceed forty-eight (48) hours. Complies with Homecare Agency’s Compliance Plan. Complies with Homecare Agency’s Infection Control Policies. Complies with Homecare Agency’s HIPAA Policies. Working Environment: Field experience may expose employee to temperature extremes, physical injury by patient, family, animal or other in the community, unsafe environment or exposure to infectious diseases and offensive odors.
Equipment and Supplies: Prudent and efficient use of routine office supplies and equipment. Prudent and efficient use of routine medical supplies, sphygmomanometer and stethoscope, and equipment. All the preceding items should be protected from theft and weather at all times. Knowledge and Competency: Must demonstrate basic knowledge of all job duties in the Medical Social Worker description. Must have the ability to follow instructions from the physician, DON/Agency Supervisor and other professional staff.
Ability to communicate effectively with managers, patients, families and co-workers. Must have effective means of transportation, which will enable employee to make visits to patients’ homes if needed. Must be able to assess safety of home situations for self, patients, and other staff members, including physical and psychological dangers. Must have the ability to effectively cope with patients, families and all others with varying backgrounds, socioeconomic conditions, and value judgments.
Skills include the ability to use cognizant approach to problem solving in delivering patient care with considerations being given to the patient’s past experience, finances and other resources. Skills are needed to assess both physical and psychological needs of patients and institute the appropriate nursing intervention. Must possess ingenuity to handle medical and situational emergencies. Maintains confidentiality of information relating to patient.
Will discuss only those aspects necessary to care and treatment of patient with those directly involved in the patient’s care. Ph