Hospice Social Worker MSW - HomeCare

Location: 765 Fairfield Ave, Bridgeport (10411)

About the role

Join Hartford HealthCare at Home, Connecticut’s largest provider of homecare services with over 115 years of fulfilling our mission. As a Social Worker (MSW), you’ll be part of a comprehensive healthcare network where every moment matters, working within our Person-Centered Care Model to provide integrated support to patients in their homes. This role offers a rewarding environment that promotes autonomy, allowing you to make real differences in the lives of clients and their families.

Responsibilities

• Collaborate with the interdisciplinary team to identify patients who would benefit from Social Work Services through IDT/case communication.
• Complete comprehensive in-home psychosocial evaluations, considering:
  • Developmental, social, cultural, substance abuse, psychological, environmental, and medical issues.
  • Physical, social, emotional, and familial characteristics.
  • Use of evidence-based assessment tools (e.g., Dementia, Depression, Anxiety, home safety, family dynamics, caregiver strain, suicide risk).
  • Patient/family understanding of disease treatment options, strengths, supports, and barriers to care.
  • Determine appropriate level of care, including needs for skilled-nursing facilities, assisted living, or adult day care.
• Collaborate with patients and families to create culturally competent care plans with measurable goals.
• Implement short-term interventions to address barriers and promote health and well-being, including:
  • Clinical treatment services (triage, crisis intervention, individual/family therapy, screening, and planning).
  • Motivational Interviewing and Coaching to assist patients/families in identifying and addressing goals.
  • Encouraging self-determination and independence using identified strengths.
• Educate patients, families, the community, and professionals on disease prevention, progression, health maintenance, and treatment adherence.
• Advocate for patients to improve access to care and service delivery.
• Provide ongoing assessment of patient and family needs, adjusting care plans as necessary.
• Maintain timely documentation of social work services, reflecting patient/client systems’ information for assessment and treatment.
• Facilitate team-based care and collaboration:
  • Work with primary care and specialty physicians to improve quality of life.
  • Participate in case conferences and IDT meetings as an integral member of the multidisciplinary team.
  • Assist the healthcare team in understanding social/psychological factors related to patient care.
  • Act as a consultant for agency staff regarding abuse, neglect, exploitation, and community resources.
• Identify HHC and community-based resources for patients and families as appropriate.

Requirements

• 2-3 years of healthcare experience, including acute and community health settings.
• Licensure: LMSW required; LCSW preferred.

Skills

• Considerable knowledge of social, cultural, economic, political, religious, medical, psychological, and legal issues influencing patient and family behaviors.
• Familiarity with evidence-based assessment tools (e.g., PHQ-9/PHQ-2, SLUMS, BIMS, FAST, SAD Caregiver Strain Index).
• Ability to identify and obtain community resources (town/state/federal programs and eligibility requirements).
• Strong critical thinking and independent judgment, with the ability to respond appropriately to crisis situations.

Benefits

Hartford HealthCare offers a competitive benefits program designed to ensure work/life balance, along with exciting opportunities for career development and growth across the state.