Job Description
Purpose of Position Plans, organizes and implements social work services to patients and families both in the hospital and outpatient practice settings. Plans for discharge and after-care. Maintains contact with referring agencies and related people, and with community resources used for referral.
Description - Provides counseling and support to families living with Alzheimer's disease or a related dementia at their home, in hospital setting, at Neurologists of Cape Cod or other approved office
- Assist with medically related emotional and social needs of patient. Identify patient and family psychosocial, mental and emotional needs along with providing, developing and/or aiding access of community services to meet those needs
- Assist patient's family and medical care team with community outreach, providing education and counseling regarding available local dementia support services. Assist with marketing of MACC services, with emphasis on growing opportunities for MACC Dementia programs and services throughout the organizational service area
- Works in collaboration with Emergency Department(s) and Inpatient Unit(s) at CCH/FH and other entities as needed on ensuring a screening process and protocol that provides appropriate recognition of dementia/delirium and follows up regularly to ensure compliance
- Works in collaboration with Emergency Department(s) on cognitive status integration into plan(s) of care, including pain identification, quiet areas for patients and ensuring family/caregiver inclusion
- Provision of professional and community educational programming, individual and family counseling services and new supportive services
- Provide Community Education by designing and delivering presentations for events as needed
- Assist with providing a smooth transition for clients and families moving from home care, to day care programs, memory care units, skilled nursing facilities and hospice. Assist with quality of life care planning
- Provides information to patients and families regarding Medicare/Medicaid and other financial assistance programs available
- Work cohesively with all support staff and volunteers for the program
- Works in collaboration with Emergency Department(s) on ensuring safe discharge/transfer integrated processes for follow up
- Works in collaboration with Emergency Department(s) and Inpatient Unit(s) on ensuring the use of BEERS criteria to identify medication changes that could influence cognitive status
- Provides Education and training on Alzheimer's/Dementia as needed
- Assist with arranging and triaging new patient consultations at Neurologists of Cape Cod, particularly those patients cared for at Emergency Department(s) and Inpatient Unit(s) at CCH/FH
- Assists in other job-related duties as assigned.
Challenges current working practices; identifies process improvement opportunities and presents recommendations and solutions to management. Engages and commits to the organization's culture of continuous improvement by actively participating, supporting, and promoting CCHC Pillars of Excellence.
Qualifications - Master of Science in Social Work (or a comparable Master's degree)
- Current licensure as required by the state of Massachusetts (L.I.C.S.W.)
- Minimum of 3-5 years of individual and family counseling, with experience in varied settings (private, facility...)
- Knowledge of statistics and trends relative to dementia
- Ability to: Establish the goals, vision, and overall direction of a department; create and implement departmental standards, systems, staffing plan and processes; analyze issues and create and effective plan to address them; critically and comprehensively evaluate the department's outcomes; identify, collect and analyze data related to the internal and external environment as well as departmental functioning; and, develop and educate staff.
- Ability to form positive, collaborative relationships with members of the community, patients, executive team, physician offices, post-acute providers and payers
- Knowledge of information systems to support the evaluation of current capacity as well as future needs.
Job Tags
Work at office, Local area,