The professional social worker whose duties and responsibilities center on the care management of Veterans in the Community Living Center. The incumbent provides coverage for the Palliative Care Coordinator which includes tracking of hospice/palliative care, coordinating and finalizing referrals for admission to the inpatient hospice/palliative care unit and for home hospice services, conducting debriefings with hospice/palliative care staff. -Interviews Veterans and their family members/significant others to establish facts about the Veteran's situation, presenting problems and their causes, and the impact of such problems on the Veteran's functioning and health as part of a comprehensive psychosocial assessment. Interprets and explains VA's treatment and benefit programs. -Reviews all data, subjective and objective, and makes a clinical assessment identifying needs and strengths. Effectively uses professional skill, objectivity, and insight. Uses advanced clinical training, insight, and experience to interpret data and to identify viable treatment options. Assesses high risk factors, acuity, and need for services. -Has the ability to serve Veterans who tend to have frequent and severe crises, lack family or an adequate community support network, be poor at self-monitoring, frequently fail to comply with instructions and treatment, or have significant deficits in coping skills and require continuing professional psychosocial support. -Independently evaluates the client's situation, including the Veteran's reaction and ability to deal with it, and arrives at a reasoned conclusion. Based on the psychosocial assessment, uses professional judgment and advanced practice skills to make a psychosocial diagnosis. Assesses at-risk factors and develops a preliminary disposition plan involving the Veteran and family or significant others. Performs insightful assessment of serious and complicated cases involving psychiatric illness involving psychiatric, catastrophic medical conditions, dementia and other high-risk diagnoses. Makes independent professional decisions and recommendations for agency action. Consequences to the Veteran may be serious, and the results are often unpredictable. -On an inpatient/outpatient basis, finds a suitable means of treatment to help Veterans and/or significant others copes with stressful situations. Treatment is aimed at helping Veterans find practical solutions to problems. -Develops psychosocial treatment plans in coordination with interdisciplinary team members, including goals for psychosocial clinical treatment. Using known available resources and the initial assessment of the Veteran's likelihood to accept differing types of assistance, make initial and continuing decisions regarding use of VA and non-VA services and referrals. Arrives at a reasoned conclusion as to the preferred course of agency action. Provides independent consultation and makes recommendations to interdisciplinary team on course of treatment. -Independently concludes the appropriate action, even in instances where actions can have serious impact on the life of the Veteran. This might include long-term institutional or nursing home care or separation from family members. These decisions are based on advanced practice skills, professional judgment and the expertise regarding the Veteran's self-care capability, the family support system, the Veteran's health care needs and possible consequences. Work Schedule: M-F Part Time 32 hours a pay period Financial Disclosure Report: Not required
Internal Number: 599206400
About Veterans Affairs, Veterans Health Administration
Providing Health Care for Veterans: The Veterans Health Administration is America’s largest integrated health care system, providing care at 1,255 health care facilities, including 170 medical centers and 1,074 outpatient sites of care of varying complexity (VHA outpatient clinics), serving 9 million enrolled Veterans each year.