Social Worker (MSW)

Preferred Skills

• Experience working on a multi-disciplinary team in a hospital, nursing home or community-based setting is preferable.

Essentials

• Performs in person initial assessments for enrollment of potential Senior Community Care participants to obtain a complete psychosocial history, which may include descriptions of cognitive status, social supports, family dynamics mental health and substance dependency and other issues and needs. Coordinates with the Interdisciplinary Team to develop a comprehensive plan of care for each participant.
• Conducts in person re-assessment of enrolled participants every six (6) months and as needed.
• Functions as a member of the Interdisciplinary Team. Maintains regular attendance at and participates in Interdisciplinary Team meetings; communicates participant changes, collaborates on plan of care decisions and coordination for twenty-four (24) hour care delivery.
• Provides ongoing support, counsel, and education to participants and family regarding a variety of issues, including but not limited to: the aging process, dementia, grief and loss, end of life, disease processes, difficult family dynamics and changing roles, PACE model and PACE health services.
• Presents requests to Interdisciplinary Team for and coordinates admission/discharge to contracted facilities for temporary respites and permanent placement.
• Acts as facilitator for meetings with participant, family, caregivers, and community agencies to clarify, or problem solves issues regarding the plan of care. Mediates discussions between all parties.
• If hospice care is appropriate actively provides emotional support, grief work, education and funeral/financial planning referral. Facilitates hospice or nursing home placement as needed. Initiate referrals to external resources with community agencies such as Adult Protective Services, Housing Authority, or public utility companies. Advocates with these entities for purposes of maintaining community stability.

Senior Community Care of North Carolina - PACE

Senior Community Care of North Carolina - PACE is part of Volunteers of America National Services which serves as the Housing and Healthcare affiliate of the Volunteers of America parent organization.

• PACE is a Program of All-Inclusive Care for the Elderly.
• Our team members include clinical professionals, personal care providers, van drivers, activity assistants and culinary employees among others.
• Unlike some clinical environments, PACE centers offer employees flexible work schedules, with most positions only requiring occasional weekends.
• Team members have an opportunity to get to know their patients and build meaningful relationships.
• SCCNC helps foster a work-life balance by offering employees paid-time off benefits as part of our comprehensive benefits package.

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