Eligible for a $5,000.00 (less taxes) sign-on bonus, paid out in installments with a work commitment.
- NLH member employees and those with a service break of less than one year are not eligible.
The position is responsible for ensuring residents attain or maintain the highest practicable physical, mental, or psychosocial well being and addressing associated family issues. The Manager of Social Services will continually develop and revise written policies and procedures to ensure services are provided in accordance with state and federal regulations and meet professional standards of practice.
Obtains psychosocial history and participates in the Comprehensive Assessment and development of the care plan by the multidisciplinary team. Assuring psychosocial needs are addressed.
Review of information collected by the Admissions Coordinator with the admission team for appropriateness of admission and availability. The Admissions Coordinator conducts the pre-admission interview with the assistance of the Manager of Social Services as needed.
Ensures each resident is visited by Social Services within 72 hours after admission in order to assist in the adjustment to the facility and to assess the immediate needs of the resident.
Collaboratively working with the Admissions Coordinator in informing the resident and/or the legally responsible party of property and Resident Rights/responsibilities on the day of admission. Giving the patient the opportunity to review policies and be fully informed. Documentation per facility practice.
Ongoing timely visits for identification of the resident's medically related social and emotional needs and to furnish continued services, as needed.
Assisting residents with support at critical periods (i.e. discharge or admission) and throughout residents stay.
Establishing a continuing relationship with family members and significant others. Staying in contact with these members whether nearby or long distance in order to encourage their involvement with the resident.
Consulting with other nursing home staff to share pertinent information about the resident'sneeds or problems.
Sustaining, contacting, and maintaining the relationship with the staff of outside agencies who share responsibilities of the residents.
Participating in team conferences under the direction of the Resident Services Director on a weekly basis for individual residents in order to coordinate the resident'scare and discharge plans.
Arranging and coordinating supportive community services as needed, and when coordinating discharge plans, contacting all community services appropriate for that resident.
Attending local Social Service Organizational Meetings (i.e. under the auspices of Maine Health Care).
Participating in community events and serving in community roles when time permits, and when it relates to Social Services and/or enhances the quality of life for the residents.
Documenting in progress notes results of problems that may have arisen in team/family conferences.
Assisting with Emergency Psychiatric Transfers when needed.
Performing any other related duties to maintain the resident'ssocial and emotional well-being.
Assisting the resident and family with discharge plans including an evaluation of the environment to which the resident will transfer, and referring to the appropriate community support services.
Preparing residents and families for changes in environment and counseling them about changes in responsibilities they will face prior to discharge (i.e. arranging visitation of new living situation before discharge takes place when appropriate, arranging for families to receive nursing education prior to home discharge, or having a team conference for discharge planning, etc.).
Insuring appropriate social work information is exchanged with the facility or agency the resident will be utilizing (i.e. hospital, home health, boarding home, other nursing facility, etc.). In emergency situations of a resident'shospital transfer, nursing has been assigned to give the facility the identifying information they need (i.e. next of kin, phone numbers, etc.).
Attending in-service programs, workshops and seminars related to Social Service and Discharge Planning.
Working with the Department of Human Services Medical Social Worker in finding appropriate placement as necessary for those residents who have been classified to a lower or higher level of care. And, when needed, consulting with physician and nursing concerning resident needs to ensure safe discharge planning.
Acting as an advocate for Resident Right'sand to protect resident interests with other departments within the facility.
Remaining knowledgeable about rules and regulations that license and govern nursing facilities, community resources, legal issues (i.e. guardianship, Adult Protective Services, legal services for the elderly, Ombudsman, Fraud Squad, financial programs, etc.).
Participate in orientation of new employees by informing them of resident rights and abuse and neglect policy.
Social Service Department will help facilitate family council meetings and inform residents annually of their right to establish one.
Assures days awaiting placement applications are completed as well as appropriate documentation and follow up.
Tracks medical eligibility assessment dates and assures timely referrals are made to the medical assessment contractor.
Overseeing other social worker to assure departmental requirements are met. Some duties above are shared with or delegated to subordinate.
Procedures Under Regulation
The records shall be prepared and maintained by the Social Worker in accordance with the regulations governing the licensing/functioning of a Nursing Facility (N.F.). The facility will treat all information pertaining to the residents and resident'srecord in accordance with the confidentiality procedures established in section19.A.1. of these regulations. Each resident chart in the facility will contain an easily identifiable Social Service Section that will contain the following:
For a longer-term resident (NF), an initial Psychosocial History and Psychosocial Assessment will be completed within one month of admission. For a Medicare Skilled resident (SNF), an initial Psychosocial History and Psychosocial Assessment will be completed within 7 days of admission. (After a consent form is signed, information may be obtained from residents, family members, appointed representatives, referral sources, and appropriate social agencies. This data will be made available to nursing home staff to facilitate their dealings and involvement with the resident.
A Social Service Care Plan is developed within 21 days of admission for every resident as deemed necessary. For NF residents, their plan of care is reviewed at least quarterly and for SNF residents, their plan of care is reviewed monthly or when significant change occurs.
Progress notes are made as needed when changes occur with the resident. For NF residents, progress is to be documented at least quarterly even if no changes occur. For SNF residents, documentation of progress will be made at least monthly.
For NF, a discharge plan is documented within one month of admission and updated quarterly or when there is a significant change. For SNF, the discharge plan is documented within 7 days and reviewed/updated every 30 days.
Psychosocial History and Assessment, Social Services Care Plan and Discharge Plan will be updated as needed, but at least quarterly for NF and monthly for SNF.
Required Licensed Social Worker
Required Bachelor's Degree