The Alzheimer Society of Niagara Region's mission is to advocate for and with people with dementia and their care partners and provide access to a diverse range of appropriate resources and supports. Particularly, to alleviate the personal and social consequences of Alzheimer's disease and other dementias and to promote research.
Our vision is to create a community where individuals with dementia and their care partners are fully supported to maximize their quality of life and well- being. Ultimately, a world without Alzheimer's disease and other dementias.
Our Values
C
ollaboration, A
ccountability
, R
espect
, Excellence
The Alzheimer Society of Niagara Region (ASNR) is a community support service organization that provides programs and services to people living with dementia and their care partners in the Niagara Region. We work closely with other service providers to ensure quality care and support for our clients.
We employ administrative and fund development staff, educators, social workers, nurses, therapeutic rec staff, personal support workers and volunteers who work together as a team to meet the needs of people living with dementia and their care partners.
We recognize the value and dignity of each individual and ensure everyone has genuine, open, and unhindered access to employment opportunities, free from any barriers, systemic or otherwise.? We are dedicated to building a diverse and inclusive work environment, where the rights of all individuals and groups are protected and all members feel safe, respected, empowered, and valued for their contributions.
We value
justice
and?
connection
?and these are the guideposts we use for decision-making of all kinds.? We believe that this will guide the organization toward a place of inclusion for all - where equity and access to essential supports and services becomes the reality
The First Link Care Navigator (FLN) will coordinate and integrate supports and services around the person living with dementia and their care partner who are referred to ASNR and not receiving services from the Family Support or Intensive Programs. In this direct client service role, they will be the key "go-to" person for families after a dementia diagnosis, with responsibility for identifying needs, supporting self-management goals, and strengthening the communication and care planning linkages between ASNR programs, other providers and across sectors along the continuum of care. The First Link Care Navigator will work collaboratively with the First Link Coordinator to ensure that people diagnosed with dementia and their care partners have timely access to information, learning opportunities and support when and where they need it in order to achieve the following outcomes:
increase system capacity to provide families facing a dementia diagnosis with system navigation support
improved client experience and health for the person living with dementia and their care partner(s)
greater care partner capacity and competency to effectively manage their role and reduce incidence of crisis situations
enhanced capacity for the person living with dementia to remain in their own home and community for as long as possible
Position Description
Title:
First Link Care Navigator
Reporting To:
Chief Operating Officer of Clinical Services
Salary:
$58,000 - $63,000 - (Contract until March 31, 2027-Pending renewal based on funding)
3 Weeks paid vacation (Pro-rated to calendar year)
Duties and Responsibilities
Assessment and Care Planning:
Pro-actively oversee incoming FLN referrals to facilitate early intervention and ensure that clients (people living with dementia and their care partners) have a named point of contact for care navigation support as early as possible before and/or after diagnosis
Triage and coordinate FLN intake referrals based on level of risk, link clients to appropriate education, support services and resourcesand assign if necessary to family support counselling department.
As required, gather information, conduct or review relevant assessments, and meet with clients (people living with dementia and care partners) to identify current and future needs, goals and level of risk.
Establish appropriate intervention plans to meet bio/psycho/social needs using a person/family-centred approach
Identify needs related to care coordination across service providers and outline responsibilities of all parties
Navigation and Care Coordination:
Support clients in navigating the system to access appropriate learning opportunities, support services, care and resources as identified in their individualized plan of service
Pro-actively facilitate linkages, communication, information exchange and coordination between clients and service providers along the continuum of care
Facilitate care conferences between clients/care partners and members of client/care partner care team, as necessary.
In collaboration with internal and external parties, engage in problem solving and develop strategies to address/overcome barriers in effective coordination/integration of supports and services
Leverage and maintain positive working relationships with physicians, health care professionals, health and community support service providers (e.g. hospitals, primary care, memory clinics, mental health, BSO, long-term care, retirement homes, police/EMS, specialized geriatrics, community Health Links), and other relevant partners through proactive outreach activities
Support awareness of First Link to health professionals, service providers and other relevant community stakeholders in collaboration with internal and external partners
Facilitate ASNR Support Groups for people living with MCI or Dementia or their partners in care
Participate in internal/external committees on an ad hoc basis
Pro-active Follow-Up:
Monitor and provide proactive follow-up for clients that have not directly been assigned a Counsellor to ensure ongoing collaboration across services/providers and to identify opportunities for new or emerging care options to meet changing needs and to address service/support gaps
Provide supports to people living with dementia and care partners as they transition through use of different parts of the health, social and residential care systems
Memory Clinic:
Serve as the Alzheimer Society Niagara Region's representative within the Primary Care Memory Clinics of the Niagara Region, offering crucial support to individuals and families receiving comprehensive assessment.
Collaborate with clinics' multidisciplinary teams to create compassionate care plans and educate patients and caregivers post-diagnosis.
Monitoring/Evaluation:
Collect, maintain and report required quantitative and qualitative data to support province-wide monitoring, evaluation and reporting
In collaboration with the Alzheimer Society of Ontario and Niagara Ontario Health Team, participate in planning and implementation of evaluation to examine the overall effectiveness of First Link referral, intake, navigation, care coordination, and proactive follow-up functions, to ensure a timely response to emerging needs
Service Delivery Standards and Quality Improvement:
In collaboration with the First Link Coordinator, maintain confidential, accurate and current client records, including complete and thorough documentation for each client contact, in compliance with relevant privacy legislation and in accordance with professional standards and internal policies
Ensure that client consents, privacy, and confidentiality are maintained in compliance with legislation, professional standards/regulations and internal policies
Maintain an advanced level of knowledge of Alzheimer's disease and other dementias, including clinical manifestations, behaviours, current care practices, treatment options, placement options, available community resources, and all relevant legislation
Assist with the development and maintenance of policies, procedures and resources to support First Link referrals, intake, system navigation, care coordination, and follow-up activities
Participate in knowledge transfer and exchange and collaborate with Alzheimer Societies across Ontario to support the delivery of best practices and ongoing quality improvement
Other Duties
Perform other duties consistent with the job classification, as required
Qualifications
Regulated Healthcare Professiona
l with current registration with the College of Social Work/ Social Service Worker or Nursing or other professional registration acceptable to the employer
Minimum
Bachelor's degree
in social work, gerontology, or other related health care discipline;
or a relevant college-level diploma
(e.g., Social Service Work)
Knowledge of available community services/supports and clinical, social and residential care options
Police Vulnerable Sector Check
Must have a valid driver's license and access to a reliable vehicle
As ASNR clients include the most vulnerable persons, it is strongly recommended that all staff be immunized to help prevent the transmission of infections.
Other Skills and Experience:
Experience and knowledge in the management of chronic and complex health conditions
Understanding of roles and linkages across primary care, community care and specialized geriatric services
Strong knowledge of client-centred philosophy
Knowledge of clinical practices and training models related to dementia (e.g.: P.I.E.C.E.S. and U-First!)
Experience in assessment and care planning/coordination
Experience working in settings requiring inter-professional collaboration
Excellent verbal and written communication skills
Exceptional interpersonal skills, including shared decision-making and facilitation
Ability to prioritize workload and manage competing tasks
Ability to take initiative and be resourceful
Excellent problem-solving and change management skills
Proficiency in technology (e.g.: Microsoft office and case management and care coordination systems)
Demonstrated ability to work independently and within a team
Expertise and experience in cultural sensitivity and diversity
Commitment to continuing professional development
Ability to speak French or other languages an asset
Physical Demands and Working Environment:
No special physical demands are required beyond the performance of general office duties.
Everyday risks or discomforts may require safety precautions typical of an office environment, i.e. use of safe work practices with office equipment, proper ergonomics, etc.
Extended periods of visual concentration; extended periods of sitting in a stationary position.
Equipment is utilized which is common to the office work environment (i.e. computer, printer, photocopier, multi-line telephone, fax machine, etc.).
Required presentations and consults outside the office can vary in environment settings to include but not limited to residential homes; long term care facilities; community organizations and hospitals
We adhere to a scent free environment.
Commitment to Equity, Diversity, and Inclusion
The Alzheimer Society Niagara Region?welcomes those who have demonstrated a commitment to upholding the values of equity and social justice and we encourage applications from First Nations, Inuit and Metis, Indigenous Peoples of North America, Black and persons of colour, persons with disabilities, people living with dementia, care partners and those who identify as LGBTQ2S+.
Commitment to Accessibility
In accordance with the Accessibility for Ontarians with Disabilities Act, 2005 and the Ontario Human Rights Code, The Alzheimer Society Niagara Region will provide accommodations through the recruitment process to applicants with disabilities. If selected to participate in the recruitment and selection process, please inform the Hiring Manager of the nature of any accommodation(s) that you may require in respect of any materials or processes used to ensure your equal participation.
Job Type: Full-time
Pay: $58,000.00-$63,000.00 per year
Benefits:
On-site parking
Paid time off
Application question(s):
Are you regulated health care professional with current registration to an Ontario college?
Education:
DCS / DEC (required)
Experience:
Dementia Care: 3 years (preferred)
Licence/Certification: