Provide Medical Social Services to the patient and/or family according to the Plan of Care. Conduct a psychosocial assessment as part of the comprehensive assessment within 5 days of admission to the hospice program. This includes emotional, social, financial and environmental resources and to identify appropriate psychosocial problems, interventions and goals for the patient’s plan of care. Participate in IDG meetings and the development of the patient’s plan of care. Observe, record and report changes on the patient's emotional and social factors that are being affected by the patient's illness and his/her need for care and his/her response to treatment. Maintain and submit written clinical records as deemed by the Agency, including the initial evaluation, the care plan and daily notes. Evaluate the patients and family's response to, and effectiveness of, the medical social work intervention. Confirm, on a weekly basis, the scheduling of visits with the patients’ Case Managers to facilitate coordination of other staff visits. Participate in IDG and QAPI meetings and activities. If the patient/family declines Social Work services, the Social worker continues to offer support to the IDG in it’s care of the patient and to monitor the patient/caregiver’s evolving needs. Participate in discharge planning, as needed. Assume responsibility for self-development by continually striving to improve his/her Medical Social Worker practice through formal education, attendance at workshops and conferences, active participation in professional and related organizational meetings, and/or individual research and reading. Assess the patient's/ family members’ ability to cope with the patient’s dying. Act as consultant to the members of the health team, assists them in understanding the social, emotional and environmental factors related to the patient's health problems. Help patients to utilize the resources of their families and the community.
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