Social Worker MSW

Job summary

Assess, plan, monitor, and evaluate care for frail and complex older adults, including early intervention and discharge planning to support successful transitions and prevent avoidable hospital admissions. Advocate for patients and caregivers by coordinating hospital and community resources, and contribute to professional practice and program initiatives.

Job details

The Social Worker functions as a valuable member of the interdisciplinary team and provides care to frail, complex senior patients at the Hamilton General Hospital and Juravinski Hospital. 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 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 professional practice and program committees & initiatives that support patient care, and clinical practice. Masters or Bachelors Degree in Clinical Social Work from an accredited School of Social Work Current Certificate of Registration with the Ontario College of Social Workers and Social Service Workers Demonstrated expertise in complex geriatric assessment, and developing individualized coordinated care plans for seniors living with multiple chronic diseases, frailty, and cognitive impairment Minimum of 3-5 years clinical experience in working with older adults in an in-patient setting, including experience with discharge planning Expert knowledge of legislation that impacts on seniors, including the Substitute Decision Makers Act and issues related to capacity and decision-making Expert knowledge of community-based resources for seniors and people with multiple medical issues Ability to creatively problem solve and facilitate change Understanding of the social determinants of health, and the social consequences and risk factors associated with aging Demonstrated strength in case management, consultation, and teamwork Demonstrated proficiency in report writing relating to assessment, and consultation Excellent written and verbal communication alongside strong interpersonal skills Understanding of diversity as it affects different populations and service delivery Evidence of self-motivation, enthusiasm, and flexibility Demonstrated commitment to ongoing learning

What you’ll do

Assess, plan, monitor, and evaluate care for frail and complex older adults, including early intervention and discharge planning to support successful transitions and prevent avoidable hospital admissions. Advocate for patients and caregivers by coordinating hospital and community resources, and contribute to professional practice and program initiatives.

Requirements

Requires a bachelor's or master's degree in clinical social work and current registration with the Ontario College of Social Workers and Social Service Workers. Candidates need 3–5 years of inpatient experience with older adults, expertise in geriatric assessment, care planning, seniors' legislation and community resources, and strong case management, communication, and teamwork skills.

Listed skills

• Care Planning · Preferred
• case management · Preferred
• community resource coordination · Preferred
• Communication · Preferred

Other relevant skills

Identified from the job description. Confirm important requirements above.

• Geriatric Assessment
• Care Planning
• Discharge Planning
• Case Management
• Clinical Social Work
• Patient Advocacy
• Interdisciplinary Teamwork
• Community Resource Coordination
• Complex Problem-Solving
• Consultation
• Assessment and Report Writing
• Communication
• Knowledge of Seniors' Legislation
• Capacity and Decision-Making
• Understanding of Social Determinants of Health
• Cultural Diversity
• Decision Making
• Enthusiasm
• Interpersonal Communications
• Report Writing
• Self-Motivation
• Teamwork
• Advocacy
• Verbal Communication Skills
• Integrated Care
• Clinical Experience
• Social Work
• Social Justice
• Chronic Diseases
• Clinical Practices
• Social Determinants Of Health
• Geriatrics
• Health Risk Assessments
• Medical Frailty

Job areas

• Healthcare
• Social Services
• Medical Social Worker
• Family / School / General Social Worker
• Social Work and Counselling Professionals
• Child, Family, and School Social Workers

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