Job Description

Mission Statement: : Understand the aspirations of seniors and respond with innovative supports.



Vision Statement: : Building inclusive communities where all seniors are connected to living their best possible life.

Position: : Gain Social Worker


Hours of Work: : 35 hours per week (Full Time; Permanent)

Reports to: : Gain Manager

Date Posted: : February12th, 2025

Deadline: : Until position is filled
Position Summary: :

The Social Worker in Geriatric Assessment Intervention Network (GAIN) Community Team participates fully in the process of comprehensive geriatric assessment (CGA) and delivers community specialized geriatric services



Responsibilities: :

1. Participate in inter-professional Comprehensive Geriatrics Assessment (CGA) :
• Complete clinical triage for new referrals
• Gather and record data within all domains of Comprehensive Geriatric Assessment (CGA)
• Conduct interview with patient and family, utilizing strength-based and person-centred approach

2. Provides patient and family-centred case management :
• Conduct assessments, prepare person-centered/goal-oriented care plans, and provide case management for patients, as part of the GAIN Community Team
• Provide crisis management, counseling and follow-up plans, as required, including liaising with the patient's family/caregiver and/or other care providers

3. System navigation, information and referrals :
• Focus on supporting patients to manage transitions, whether between GAIN's own services or across multiple service provider
• Participate in the prevention of adverse outcomes through environment optimizing, and provide support to assist in minimizing the risk of traumatic and adverse events (medically and psychosocially)

4. Promote health and safety of patients, staff and self :
• Comply with the Seniors Persons Living Connected "Client Safety," "Risk Management," and "Health and Safety" policies, and regulated requirements of affiliated professional association
• Work safely at all times and ensure the safety of self, co-workers and patients by preventing hazard and reporting hazards to the supervisor

Other duties that may be assigned from time to time



Education: :
• Bachelor's degree in social work or related field
• Membership in good standing with a regulatory body in Ontario - Ontario College of Social Workers and Social Service Workers (OCSWSSW) required
• Certificate/s in counselling an asset
• Valid First Aid and CPR certificate an asset

Experience & Skills: :
• Two to three (2-3) years' experience working with an inter-professional team in a healthcare setting
• Experience working with older adult population and knowledge of geriatric conditions
• Extensive knowledge on how to effectively serve an increasingly aging population with complex medical, functional, cognitive, and psychosocial needs
• Knowledge of assessment, counseling, and case management
• Sound understanding of community resources (social, legal, health and financial)
• Good assessment skills for evaluating dementias, cognitive impairments, depressions, and deliriums, mental health and addictions
• Sensitive to the cultural needs of patients from various ethnic groups
• Excellent interpersonal, communication, decision-making and assessment skills
• Ability to work independently and co-operatively in a busy multi-disciplinary situation
• Experience in conducting home visits for patient care an asset
• Fluency in a second language an asset

Working Conditions: :
• Required to work at satellite sites (remotely), in patient's home, in-clinic, and with caregivers,
• Required to work occasional evening and weekend hours
• Regular interruptions to support patients'/patients' needs and crises
• Regular exposure to computer terminal
• May be exposed to infectious wastes, conditions, and communicable diseases
• Interacts with patients, family members, staff, visitors, and government agencies

Other :
• Vulnerable Sector Check required
• A valid Ontario driver's license and a car is required for home visits




Senior Persons Living Connected is a diverse work environment. We encourage applications from all persons, including persons with disabilities. Accommodation will be provided, if needed, in accordance with the Ontario Human Rights Code and Accessibility for Ontarians Disability Act.



While we thank all applicants for their interest, only those applicants selected for interview will be contacted.