The Medical Foster Home (MFH) Program Coordinator is a social worker who is responsible for maximizing psychosocial quality of life issues in order to assist veterans to remain in their home or in a less restrictive level of care other than a nursing home, and keep them out of the hospital as often as possible. Responsible for the overall function of the Medical Foster Home Program at the Salisbury VA Medical Center In charge of program development, recruitment, and development of the foster homes, recruitment and placement of veteran residents, case management, development of policies and care processes, and coordination with HBPC interdisciplinary treatment teams Responsible for the selecting of homes and residents, establishes intake processes, establishes oversight responsibilities, and maintains a record-keeping system for the program Responsible for marketing the model of care and reaches out to community groups and agencies to promote the foster care program, and serves as a mentor to other VA MFH program coordinators, social workers, and other interested health care providers Responsible for providing training to caregivers, students, residents, interns and fellows from other disciplines regarding the advantages and disadvantages of a medical foster home Possesses extensive knowledge of medical center policies and procedures, VHA and VBA regulations Receives and completes consults from interdisciplinary teams and other social workers on complex, difficult cases, using advanced practice skills and expertise Provides consultation to referral sources and is responsible for development and maintenance of professional standards of practice and educating others Independently documents in the medical records utilizing paper and/or electronic formats, including psychosocial assessments, diagnostics, treatment, progress notes, follow up and referrals Interviews and conducts psychosocial assessments, interviews veteran and family members and/or significant others to establish facts about the veteran's unique situation, problems and causes, and the impact of such problems on the veteran's functioning and health as a part of a comprehensive psychosocial assessment, as well as, assessing high risk factors, acuity and need for services Interprets and explains VA treatment and benefit programs Develops an assessment of the veteran in collaboration with the interdisciplinary treatment teams, the veteran, family members and significant others, whenever possible Responsible for working within the interdisciplinary treatment teams to develop a treatment plan with the veteran based on the assessment Reviews all data, subjective and objective, and makes a clinical assessment, identifying needs and strengths Uses advanced clinical training, insight and experience to interpret data and to identify viable treatment options Develops psychosocial treatment plans in collaboration with HBPC interdisciplinary team, 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, makes initial and continuing decisions regarding use of VA and non-VA services and referrals Provides independent consultation and makes recommendations to interdisciplinary team on course of treatment Makes decisions based on advanced practice skills, professional judgment and expertise regarding the veteran's self-care capability, the family support system, the veteran's health care needs and possible consequences; including medical foster home placement Establishes a continuing relationship with the foster home caregiver and veteran, and involved family members, evaluating progress towards goals and adjusting the treatment plan as appropriate Meets with medical foster home caregiver, veteran, and/or family members to assess accomplishments and re-establish goals Monitors progress, maintains comprehensive documentation, ensures expert diagnosis and treatment of clinical disorders, and shows competent discretion in decision to adjust treatment Makes recommendations for care and changes to interdisciplinary treatment plan Provides the patient and/or caregivers and family members with ongoing supportive counseling Assists patient/and/or caregivers in coping and dealing with the loss and grief experienced in chronic illness, terminal illness and death Acts as an advocate when it serves the best interest of the veteran/family, and acts as an advocate for the VA and need for services in specific geographical areas Experienced in making rapid assessments and developing crisis management plans to maintain the veteran in a medical foster home In the event of an alleged abuse case, medical or psychiatric emergency, responsible for following the protocol of the HHCS and/or medical center policy Ensures the interdisciplinary team is kept informed of any concerns with the patient and/or caregiver Work Schedule: 8:00am - 4:30pm Financial Disclosure Report: Not required
Internal Number: 600296800
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.