Participates in the development of a written, interdisciplinary plan of care for each resident that identifies the psychosocial needs/issues of the resident, the goals to be accomplished for those needs/issues, and the appropriate social worker interventions.

• Ensures or provides therapeutic interventions to assist residents in coping with their transition and adjustment to a long-term care facility, including their social, emotional, and psychological needs.

• Ensures or provides support and education to residents/family members/significant others to assist in their understanding of placement and facility issues in addition to referring them to the appropriate social service agencies when the facility does not provide the needed services.

• Coordinates the resident discharge planning process and make referrals for appropriate home care services prior to the resident’s return to the community.

• Work with the interdisciplinary team and administration to promote and protect resident rights and the psychological well-being of each resident. Prevent and address resident abuse as mandated by law and professional licensure.

• Work with residents, families, significant others and staff to provide support, information and organization for taking a more proactive role in self-advocacy to improve the quality of life/care for individual resident and those who live and work within the facility and the community.

• Assist the Social Service Director/Consultant in the planning, developing, organizing, implementing, evaluating, and directing of the social service programs of this facility.

• Works with Director of Nursing and Administration to prepare for inspection surveys; ability to engage in interviews by inspectors, assist in immediate corrections of problems noted by surveyors, etc. Reviews and reinforces important standards previously cited.

• Other duties, responsibilities and activities may change or assigned at any time with or without notice.