Social Services Director

Ivy Hill Post Acute Nursing and Rehabilitation -

Key Responsibilities :

• Resident Assessments and Care Planning :
• Conduct initial and ongoing assessments of residents' emotional, social, and psychological needs.
• Collaborate with the interdisciplinary team to develop, review, and update individualized care plans.
• Advocate for resident preferences and ensure that their care needs are being met in accordance with their rights and personal wishes.
• Counseling and Emotional Support :
• Provide individual and group counseling to residents coping with issues such as adjustment to nursing home life, loss of independence, or chronic illness.
• Offer emotional support to families, including assisting with grief, end-of-life planning, and facilitating difficult conversations regarding care decisions.
• Crisis Intervention :
• Respond to residents or families in crisis, offering immediate support and connecting them with appropriate resources.
• Provide mediation and conflict resolution services, particularly when there are disputes between families, residents, and staff.
• Discharge Planning :
• Work with the healthcare team to develop comprehensive discharge plans for residents, ensuring they are transitioned smoothly to home care, rehabilitation centers, or other appropriate settings.
• Coordinate with external service providers, such as home health agencies, to facilitate continuity of care
• Documentation and Compliance :
• Maintain accurate and up-to-date records in accordance with regulatory requirements and facility policies.
• Complete required assessments, progress notes, and discharge reports in a timely and professional manner.
• Advocacy and Resource Coordination :
• Serve as a liaison between residents, families, and external resources (e.g., community organizations, legal services, and financial advisors).
• Assist with applying for financial assistance programs, including Medicaid, Social Security, and other entitlements.
• Ensure residents and their families are aware of available services, including recreational, spiritual, and community resources.
• Support advance care planning and ensure that residents’ end-of-life wishes are documented and respected.

Social Worker requirements :

IND123