Job description

Under the direct supervision of the Director of Social Services, the Social Services Worker will assume the responsibilities noted below. The primary purpose of this position is to assist residents, families, and responsible parties in assessing their situations; setting goals; obtaining required services. Participates in quality improvement and evaluation processes related to the management of resident care in accordance with current applicable federal, state, and local standards, guidelines and regulations,

DELEGATION OF AUTHORITY

As the Social Services Worker, you are delegated the responsibility and accountability necessary for carrying out your assigned duties.

ESSENTIAL JOB FUNCTIONS: RESPONSIBILITIES AND STANDARDS

1. Builds network of services

By

Coordinating, collaborating, communicating, and integrating information between departments, The fairhaven Nursing and Rehab and external agencies relevant to Social Service activities.

2. Determines nature of resident’s situation

By

Interviewing resident (family or responsible party) on admission and during the resident’s stay; assessing medical, psychological, emotional, and social information; problem identification (and prioritization of the problems); utilizing appropriate resources; actively participate in the care plan process; coordinating and compiling information for the MDS Assessment(s) required of all residents; complying will all regulations for MDS Assessments; monitoring and documenting the resident’s progress towards meeting resident and Social Service goals within established facility and regulatory time frames; coordinating with Admissions Coordinator placements, room assignments, individual resident/family concerns or needs upon admission.

3. Establishes course of action

By

Exploring options; setting goals with residents and families.

4. Fosters residents’ action or adjustment

By

Interpreting attitudes and patterns of behavior; explaining and pointing out new options to residents, families, and staff.

5. Maintains a working knowledge of resources

By

Obtaining lists with names, addresses and services of available services in the community; contacting other Social Service Departments and personnel in the local region for networking purposes; communicating with the Administrator; placing name on lists of external agencies to obtain referrals, feedback, and/or other information.

6. Maintains a working knowledge of the requirements of payers

By

Communicating and receiving documentation to support their requirements from the payers themselves or from the Administrator; attending payer-sponsored workshops and/or seminars; placing one’s name on their mailing list to receive current information.

7. Acts as the Discharge Planning Coordinator

By

Determining the resident’s post nursing home care preference(s); assessing the resident’s capacity for self-care; identifying the health or social care resources needed to assure high quality post nursing home care; counseling the resident, and/or responsible party (and/or family) preparing them for post nursing home care; communicating with other disciplines to facilitate the coordination of complex services and resources; working to facilitate and support the Case Manager in planning discharge and/or continual placement in nursing home as appropriate.

8. Maintains appropriate documentation (may participate in or complete in absence of the Director of Case Management).

By

Initiating the Admission Progress Note form on the day of admission (unless evening or weekend in which case will be completed Monday morning); initiating/overseeing the Discharge Plan form on the day of admission; obtaining and documenting on the Social History form information relevant to the resident’s social history within 48 hours of admission except weekends and done Monday; charting information about the resident and his/her care in the Social Service progress notes as needed; and completing the Quarterly Social Service Progress Note per the individual resident’s documentation schedule; maintaining under lock in the Director of Social Service’s office, any information that in his/her judgment should not be included in a resident’s health record; placing Medicare labels on Social Service progress note when reviewed at committee meeting; placing labels when there is a room transfer; documentation in Social Services files will be retained according to state and federal regulations; facilitating all Medicaid paperwork and coordinates concerns with Business Office, specific financial issues as requested by Administrator or Business Office arising during a resident’s stay; coordinating all paperwork and forms for compliance with admissions, period of stay and discharge; pursuing needed guardianships through coordinated effort with Administration.

9. Demonstrates flexibility and creativity in identifying resources to meet patient/family needs

By

Adjusting work schedule to meet the needs of the patient, family, or facility as needed; seeks out other discipline(s) who can contribute to the resource allocation or retrieval process; coordinating special resident/family meetings during period of stay; facilitating with the Nursing Department, resident and/or family special needs for: 1) psychiatric, 2) Hospice, 3) or Advanced Healthcare Directives.

10. Other job related duties

As

By the Administrator and that the duties are within the scope of his/her educational and clinical abilities by answering questions and requests of residents, facility staff, and families.

11. Maintains residents’ confidentiality and protects operations

By

Keeping information confidential; following release of information protocols; faxing health records in accordance with FAIRHAVEN protocol; developing Social Service policies and procedures with the Director of Case Management in accordance with standards of practice for long term care facilities; following state laws, federal regulations, and facility policies and procedures regarding the right to access and release of health information.

12. Maintains the stability and reputation of the facility

By

Complying with established requirements; projecting a personal and professional image when dealing with people external to the facility.

13. Assists in the development and presentation of inservice programs

By

Planning and developing programs on such topics as death and dying, interpersonal relationships, psychology of aging and other appropriate topics within the educational and clinical expertise of the individual; planning and developing participation in staff training; participating in general orientation of new employees on a regularly scheduled basis and instructing them on resident philosophy of THE FAIRHAVEN , Resident Rights, Resident Abuse, Mistreatment and Neglect, positive coping with residents’ daily needs..

14. Interacts with staff and other disciplines

By

Facilitating communication with the Rehabilitation Team by providing team members with an interpretation of each resident’s social and emotional environment and with advice and counsel; by providing attending physicians information about our community agencies and/or other resources pertinent to residents’ in-house and/or discharge needs; meeting professional invention through interpretation of residents’ needs and behaviors and extend professional intervention to all levels of staff, suggesting positive approaches, such as alternative use of restraints and psychotropic drugs.

15. Conserves resources

By

Using equipment and supplies as needed to accomplish tasks; reviews and analyzes needs to obtain appropriate resources to complete tasks.

16. Contributes to team effort

By

Accomplishing related results as needed; providing instruction in areas of expertise to other team members when necessary as part of the on-going educational process.

17. Prepares work to be accomplished

By

Gathering, sorting, and prioritizing documents and related information; provides direction and instructions to department personnel when and where appropriate to complete tasks as needed.

18. Complies with federal, state regulations and facility policies

By

Obtaining rules, laws, regulations, standards of practice, etc. which apply to the nursing home; developing and writing applicable Social Service policies and procedures by which the facility operates on a day-to-day function; ensuring appropriate department heads receive copies of policies and procedures.

19. Keeps equipment operational

By

Following manufacturer’ s instructions and established procedures; orders and maintains stock of equipment and supplies; monitors equipment to ensure safety and proper operations.

20. Participation in facility-wide Quality Assurance Program

By

Participating in data collection and retrieval; uses statistical methodologies to determine outcome measures; using data to estimate population means and standard deviations; instructs departmental and facility staff on the importance of managed care data management, implementation, and monitoring of data; monitoring charts for concurrent documentation to meet regulations of JCAHO, OBRA, managed care, Medicare, Medicaid, state agencies, and fiscal intermediaries.

21. Maintains professional and technical knowledge

By

Attending external seminars applicable to the Social Service Department; and attending mandatory and other facility continuing education programs.

22. Safety is monitored and ensured

By

Demonstrating, monitoring, and educating staff regarding safety rules, safe work practices, proper material handling and emergency procedures; enforcing FAIRHAVEN disciplinary system for staff who break or disregard safety rules, safe work practices, proper material handling and emergency procedures.

QUALIFICATIONS

EDUCATION

BA social worker with licensure in the State of Massachusetts

EXPERIENCE

Two (2) years or greater experience working in the long-term care field; preferably in a nursing

Home, Skilled Nursing Facility, subacute unit.

Preferred extensive knowledge of the Medicare and Massachusetts/New Hampshire Medicaid

Programs.

Preferred knowledge of JCAHO

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