Job Description

The Social Worker functions as a valuable member of the interdisciplinary team and provides care to frail, complex senior patients. The role has a dual focus: to prevent avoidable admissions by liaising with community supports; and to provide early assessment and intervention associated with best practice for geriatric patients. The Social Worker provides time-sensitive case management for admitted patients, including leadership in the coordination of transitions across different levels of care within the hospital system and back to community, as well as providing consultation/liaison to other caregivers and community agencies. The SW assesses, plans, monitors and evaluates client goal achievement. In particular, the SW practices by combining education and related clinical experience to offer patients and their caregivers support, assessment and resource support for successful discharge with an emphasis on addressing social justice and self-determination by enhancing linkages with hospital and community services and acts as an advocate for the frail seniors they serve and where appropriate, in partnership with community resources. In addition, the Social worker will actively participate in continuing professional development opportunities, professional practice and program committees & initiatives that support patient care, clinical practice, education and research as approved by the manger.
Qualifications
1. Masters Degree in Clinical Social Work from an accredited School of Social Work
2. Current Certificate of Registration with the Ontario College of Social Workers and Social Service Workers
3. Demonstrated expertise in complex geriatric assessment, and developing individualized coordinated care plans for seniors living with multiple chronic diseases, frailty, and cognitive impairment.
4. Minimum of 3-5 years clinical experience in working with older adults in an in-patient setting, including experience with discharge planning.
5. Expert knowledge of legislation that impacts on seniors, including the Substitute Decision Makers Act and issues related to capacity and decision-making..
6. Expert knowledge of community-based resources for seniors and people with multiple medical issues.
7.Ability to creatively problem solve and facilitate change.
8. Understanding of the social determinants of health, and the social consequences and risk factors associated with aging.
9. Demonstrated strength in case management, consultation, and teamwork.
10. Demonstrated proficiency in report writing relating to assessment, and consultation.
11. Excellent written and verbal communication alongside strong interpersonal skills
12. Understanding of diversity as it affects different populations and service delivery
14. Evidence of self-motivation, enthusiasm, and flexibility
15. Demonstrated commitment to ongoing learning

Skills Required