Home Health & Hospice
Rose Rodriguez
Manager of Social Services
Pathways Home Health & Hospice
395 Oyster Point Blvd, Suite 128
South San Francisco, CA 94080
Main: 650-634-0133
Cell: 408-930-9114
Rosanna....@commonspirit.org
Medical Social Worker
For over 45 years Pathways has been a Bay Area pioneer, leader, and innovator in Hospice, Home Health and Palliative Care. We provide care at home or in settings such as assisted living, a nursing home, or the hospital. We have offices in Sunnyvale, South San Francisco, and Oakland. Patients and their families know us for our personalized, high-quality care, delivered with empathy, kindness, and respect.
TITLE: Medical Social Worker
OFFICE LOCATION: Sunnyvale
PATIENT TERRITORY: Santa Clara County
SCHEDULE: Full Time and Part Time
SHIFT: Days
The posted compensation range of $39.00 - $58.98/Hour is a reasonable estimate that extends from the lowest to the highest pay Pathways Home Health & Hospice in good faith believes it might pay for this particular job, based on the circumstances at the time of posting. Pathways Home Health & Hospice may ultimately pay more or less than the posted range as permitted by law.
POSITION SUMMARY: Provide medical social services including psychosocial assessment, counseling, and community resource information and referrals as part of the interdisciplinary home health and hospice teams.
AREAS OF RESPONSIBILITY:
• Provides education and counseling to current and prospective
hospice patients and their families regarding the Pathways Hospice philosophy,
plan of care, and services.
• Obtains informed consent from patients and families and assists
in completing forms required for hospice admissions and discharges.
• Conducts comprehensive psychosocial assessments including an
evaluation of patient/family coping, social service needs, caregiving plans,
and bereavement risk.
• Based on this assessment, develops a comprehensive psychosocial
plan of care, including individualized goals, interventions, and projected
visit frequencies. Continually reviews and updates psychosocial plan of care. Integrates input from other disciplines to
create a comprehensive interdisciplinary plan of care.
• Provides counseling and education to help patients and families
resolve issues associated with end-of-life such as anticipatory grief,
caregiver stress, anxiety, memory loss and other patient mental
status changes.
• Identifies and enhances the strengths of the family system,
including maintaining the dignity of the dying patient, assessing impact of patient/family’s unique cultural and spiritual beliefs on
patient’s end-of-life needs and educating the interdisciplinary team on this
impact as needed.
• Provides guidance, education and referrals to help patients and families access appropriate
social services including caregiving resources, advanced planning needs,
mortuary arrangements, and/or financial resources.
• Consistently communicates with family members of both home- and
facility-based patients. Maintains timely communication with patient, family, and facility staff regarding all aspects of patient
care.
• Provides discharge planning for hospice patients when moving to
a different care environment or when hospice is discontinued.
• Knowledgeably discusses and initiates non-pharmacologic
interventions as appropriate to promote comfort, improve quality of life, and
manage emotional, spiritual, and physical distress.
• Knowledgeably assesses and manages risk factors in the hospice
setting, including behavioral health issues. Conducts screening and follow-up
of patients at risk for anxiety, depression, and suicidality. Provides guidance
and leadership to other members of the interdisciplinary team regarding
mandatory reporting issues such as abuse and neglect.
• Provides periodic weekend on-call social work services including
triage and crisis intervention.
• Consults, collaborates, and coordinates with the IDG and others involved in the
patient’s care all patient and family services based on the patient’s and
family’s preference.
• Attends and actively participates in IDG meetings, presenting
relevant psychosocial information concisely and professionally. Also attends
and actively participates in educational in-service trainings and other agency meetings as requested by Social Services
Program Director/Manager.
• Collaborates with the Volunteer Resources department to train,
supervise, and consult with patient care volunteers.
• Collaborates with Bereavement Department to evaluate bereavement
risk factors, develop individualized bereavement care plans, and provide
individual and/or group bereavement counseling and education.
• Participates in facility patient care conferences, in
coordination with other IDG members, to discuss and clarify hospice care goals
and roles of team members. Initiates care conferences as needed.
• Demonstrates awareness of and adheres to the safety, infection
control, and other policies of the facility.
• Participates in quality improvement activities related to areas
of practice as appropriate.
• Demonstrates all skills of a hospice social worker, including
those skills required by the agency through competency testing.
• Submits weekly visit schedule of assigned patients as appropriate.
Collaborates with Clinical Team Manager(s) to address scheduling needs.
• Assesses, develops, organizes and delivers teaching materials
for assigned home care patients as appropriate.
• Helps clarify, counsel and explain the use of medical
recommendations, services and options offered to Home Health patients to
restore, improve and/or maintain their optimal social and health
adjustment within the patient’s own capacity.
• Assists patients, families and staff to understand, accept and
manage the significant social, emotional, and financial factors related to a
patient's health challenges.
QUALIFICATIONS:
• MSW degree from an accredited graduate School of Social Work.
• One year of professional social work experience preferred, will
consider relevant internship experience.
• Experience and demonstrated competence and comfort working with
families in crisis, the frail elderly, the disabled and/or the terminally ill.
• Current CPR Certificate.
• California driver’s license and automobile insurance