Community Support Liaison

Responsibilities

• Covers all approved respite stays at contracted skilled nursing facilities (SNFs) and communicates details with Interdisciplinary Team (IDT) members, participants, caregivers, and SNF staff.
• Coordinates transitions of participants from short-term rehab (STR)/medical respite to long-term care (LTC) when approved by IDT as requested by the center manager and/or Medical Director.
• Serves as liaison to assist with coordination of discharge planning for STLC participants during hospital inpatient stays. Includes transitions to skilled nursing facilities and/or home.
• Provides frequent communication to caregivers and IDT members regarding discharge status, and admission status for STR/LTC.
• Covers the orientation of new direct care contract providers [this would be Life Enrichment Center (LEC), Nursing Home (NH), or Home Care].
• Oversees direct participant care requirements for contracted providers.
• Aids in the Letter of Agreement and/or Contract with providers for Center Managers once approved by Executive Program Director & Medical Director.
• Serves as contact staff member for Senior TLC’s contract providers to reach out to if/when there are concerns. When contacted, communicates with the appropriate staff member within Senior TLC to address concerns.
• Enters appropriate outcomes/interventions in participants’ care plans as related to hospitalizations, hospital/SNF discharges, etc.
• Updates EHR with admission/discharge dates for participants with inpatient stays as well as transitions from STR to LTC.
• Supports team members and functions as a team player while providing that support and adheres to the “do no harm” team contract statement.
• Accepts teammates’ differences in professional assessment findings, as they relate to participant care, and supports team decisions while promoting a united team for the participants’ continuity of care and for staff development.
• Supports Senior TLC’s mission to encourage and support the quality of life of seniors wishing to continue living in the community; its vision to be the preferred provider of individualized care for seniors in the community; and its values of respect, integrity, accountability, compatible goals, and compassionate care.

Qualifications

Education: High School Diploma or equivalent required. A graduate of an accredited school of nursing or relevant degree in Human Services preferred.

Experience: Minimum 1 year’s experience working with the elderly population.