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.

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.

Medical Social Worker

Sunnyvale

Mountain View to Gilroy

Full Time

Days

Provide medical social services including psychosocial assessment, counseling, and community resource information and referrals as part of the interdisciplinary home health and hospice teams.

• 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…