Responsibilities and Duties:
· Conduct psychosocial assessments to identify patient’s needs, strengths, and challenges in their home and in the community.
· Collaborate with patients, families and relevant organisations to develop and implement individualized care plans that facilitate the transition from healthcare facility to home.
· Actively participate in multi-disciplinary team meetings to discuss and coordinate patients’ care.
· Organise and participate in case conferences with relevant organizations and community agencies to enhance patient care and service coordination.
· Provide emotional support and counselling services to patients and their families, addressing concerns and fostering resilience.
· Conduct group sessions for patients or caregivers to provide shared learning and support.
· Assist patients and their families in accessing available community services and support to meet their needs.
· Conduct home visits and follow-up sessions to address ongoing concerns and monitor progress.
· Maintain accurate and timely documentation of patient’s care plans, interventions, and coordination efforts within medical systems, ensuring compliance with healthcare regulations.
· Implement and support initiatives and programmes to enhance the care and support of patients and their caregivers within the community.
Job Requirements:
· Degree in Social Work, preferably with 1 or 2 years’ social work experience.
· Experience in a healthcare or Social Services Agencies will be advantage.
· Registration with Social Work Accreditation Board is preferred
· Must have an interest in working with seniors and their caregivers.
· Must be able to work independently.
