Hartford HealthCare at Home
Mansfield Center, CT
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DescriptionJob Schedule: Per Diem
Work where every
Every day, almost 30,000 Hartford HealthCare employees come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut’s most comprehensive healthcare network as a Visiting Registered Nurse.
Hartford HealthCare at Home, the largest provider of homecare services in Connecticut, has been fulfilling our mission for more than 115 years. Our Person-Centered Care Model allows our employees to learn and grow within our organization, all while providing integrated support to the patient. As part of Hartford HealthCare, we leverage cutting edge technology to provide quality care in our client’s home. Most importantly, our employees are appreciated for the real differences they make in both the lives of their clients and their clients’ families.
DEFINITION: The Social Worker provides services to patients, their caregivers, and families that are needed to assist the patient and/or family with the solution of personal, social and financial problems which may interfere with the patient’s, caregiver’s and family’s quality of life. Social work interventions are provided under direction of a physician and in accordance with the plan of care.
1. Provides culturally sensitive non judgmental appropriate end of life care before and after death.
2. Conducts comprehensive assessments and evaluations of patient, caregiver and family psychosocial needs, and connects the patient, caregiver and family with community resources as needed.
a. Assesses patient, caregiver and family psychosocial needs, strengths and coping skills.
b. Identifies support systems and community resources available to reduce stress and facilitate coping with end-of-life care.
c. Makes appropriate community referrals in accordance with patient’s and family’s preferences.
d. Assesses patient’s appropriateness for Live Alone Program.
e. Regularly assesses patient’s ability for self care and caregiver’s ability to provide safe care.
f. Assesses the patient’s, caregiver’s and family’s environmental and financial resources as they relate to the provision of patient care and future family health. Makes referrals to the appropriate resources as needed.
3. Provides social work interventions as appropriate.
a. Ensures that psychosocial assessments identify issues that are impacted by the terminal diagnosis and the symptoms of the patient’s disease.
b. Conducts ongoing assessment during any contact or interaction related to the patient, caregiver and family.
c. Provides short-term individual and family counseling for specific problems solving or symptom relief.
d. Provides advocacy as needed. Ensures that interventions are initiated according to patient and family preferences.
e. Enhances the strengths of the family’s system.
f. Assesses and refers for ongoing bereavement services.
g. Maintains the dignity of the dying patient and the grieving family.
h. Supports the patient’s, caregiver’s and family’s unique spiritual and cultural beliefs.
i. Provides holistic family-centered care across treatment settings.
j. Provides appropriate crisis intervention as needed.
k. Assists with decision making and care planning and prepares advance directives as needed.
l. Provides information and assistance with decisions for funeral planning according to patient and family preferences.
m. Assists IDG in understanding significant emotional factors and helps team members address issues according to the patient’s preferences.
n. Ensures that the IDG identifies a patient’s and family’s beliefs and/or philosophies and honors these beliefs in all care decisions.
o. Relates to patients, caregiver, families and IDG members during stress periods.
p. Reports abuse and neglect to the primary team and appropriate community protective agencies.
4. Documents the evaluation and assessment of patients, caregiver’s and family’s psychosocial status, needs and interventions provided.
a. Documents clinical notes after every patient contact and includes basic content of each session, progress and future plans.
b. Completes a plan of social work treatment including goals, plans for intervention and implementation
c. Develops Plan of Care in consultation with patient, caregiver, family and IDG members resulting from psychosocial assessments and evaluations.
d. Updates/initiates MSW physician orders
e. Participates in the development and revision of the Plan of Care.
5. Maintains professional knowledge and skills by attending educational meetings, workshops and in-services, maintaining knowledge of current literature and resources, and incorporating learning into practice.
6. Participates in continuing education programs as requested or as required under state and federal regulations.
7. Provides in-service training as needed.
8. Ensures that the goals of the strategic plan that relate to community visibility and development are met.
a. Responds to community requests for information and education.
b. Participates in public speaking engagements as needed.
c. Serves as liaison to community extended care facilities and inpatient providers.
9. Follows organizational policies, procedures and standards.
10. Attends and participates in required meetings.
11. Ensures optimal communication to support agency operations.
1. Master's degree in social work from a school accredited by the Council on Social Work Education with a minimum of three (3) years clinical experience in Social Work preferred.
2. Maintains current state license for LCSW, if applicable.
3. Knowledge of social work ethics and accepted social work practice standards.
4. Willing to work the hours necessary to enable Hospice to meet its commitments to the patients/families.
5. Interest in keeping abreast of trends and developments in social work, Hospice care and related fields.
7. Ability to work as part of a team as well as function independently and coordinate activities as appropriate to accurately complete tasks in a timely manner.
8. Understands and maintains confidentiality.
9. Complies with HIPAA regulations.
10. Ability to relate well with staff, general public or individuals with a life limiting illness and their families during a stressful period.
11. Knowledge of, committed to and adherence to Center for Hospice Care concepts, philosophy, policies and procedures and reimbursement methods.
12. Computer literate, ability to learn new data bases, able to operate office equipment.
13. Maintains a current state driver’s license.
14. Retains auto insurance and provides proof of insurance. Coverage to be at current Connecticut state limit.
1. Appropriately represents Hospice mission, vision and values.
2. Able to lift 50 lbs. without restriction.
3. Vision corrected to 20/20 in at least one eye.
4. Able to tolerate prolonged periods of sitting or standing as necessary.
5. Able to accurately input, access, process and retrieve computer information.
6. Adheres to agency code of conduct and compliance plan.
7. Ability to communicate effectively in writing and using electronic devices/systems.
8. Able to articulate clearly verbally, in person, via the phone and in writing to, public, staff, patients and families.
9. Able to follow instructions in the performance of the job.
10. Able to maintain flexibility in task management.
11. Participates in employee evaluation process including self-evaluation.
12. Ability to work well with IDG and community agencies.
13. Ability to enter and exit homes, referral facilities independently.
14. Able to perform assessment of patient, family and environment.
15. Comfortable using computerized clinical records.