Social Worker, Home Health/fraser Hope Lodge

Salary range: The salary range for this position is CAD $42.27 - $52.81 / hour Why Fraser Health?:
We are currently looking to fill a** Relief Part-Time** opportunity for a **Social Worker-**Home Health** located in **Hope, BC**. This postion is available until December 3 ,2025 or until return or incumbent.

This is a unique rural opportunity for you just a short two-hour drive east of Vancouver’s city centre. Hope is an outdoor paradise with a variety of recreational opportunities and a vibrant culture all surrounded by majestic mountains and breathtaking views. To find out more about the community of Hope and all it has to offer - click here.

**Requirements**:

- Bachelor’s degree in social work
- Two years experience working with Complex Geriatric Clients/Adults with Chronic Illnesses
- Full registration with the BC College of Social Workers
- Valid BC Driver’s License and access to a personal vehicle

Detailed Overview:
Provides care management to frail older adults with complex, acute and chronic conditions and/or adults with ongoing functional impairment in their home, community setting, and/or residential care, either in person or via telephone; establishes and maintains ongoing collaborative partnerships with clients, families, Primary Care Practitioners, Home Health professionals, residential care team and other community partners to optimize client/resident capabilities and community engagement.

As a member of a multidisciplinary team, provides clinical assessments, coaching, interventions, services and follow up to enable clients and their families to live confidently and safely at home; emphasizes the promotion, maintenance and restoration of health including the treatment of diseases through teaching, counselling and direct client care; facilitates and manages client transitions across the health care continuum to optimize recovery from or adapting to changes in the client's condition to minimize re-admission to residential and/or acute care facilities.

**Responsibilities**:

- Establishes a therapeutic relationship with the client through the use of interpersonal and interviewing techniques in person and/or over the telephone to ensure the client's choice and autonomy in decision-making and care planning, including the client's right to dignity and privacy.
- Using a Care Management approach, collaborates with the client and family to conduct and document an individualized client assessment in person and/or over the telephone; develops an individualized client care/health improvement plan which reflects the client's goals and priorities with an emphasis on self-management; coaches client and/or family to increase their skills and confidence in managing the client's health.
- Provides direct client care and identifies other care services required in accordance with applicable guidelines, policies and evidence-based best practice; provides comprehensive explanations of care to the client and family as appropriate.
- Initiates and evaluates the appropriateness and effectiveness of the short and long term care plan to meet specific client goals; develops next steps in collaboration with the client and family; develops and supports a transition process for achieving client care goals across the care continuum including discharge and/or transfer to other services, as required.
- Accesses system information and resources to review client data such as medical history, progress notes, consultation reports, lab reports and incorporates findings into the care plan; plans, organizes and establishes priorities by using resources effectively and efficiently; responds to unanticipated events and/or changing client or service assignment needs, as needed.
- Documents assessments, care provision and client responses according to professional standards and established guidelines including computerized records and databases; maintains related records, documentation and statistics; prepares reports in accordance with established standards and procedures, as required.
- Provides health education to the client/family/caregiver to increase their knowledge regarding client's health and to promote/enhance the client's health status by teaching relevant procedures appropriate for care needs; develops relevant informational materials and participates in staff education programs, as required to orient new staff.
- Collaborates with members of the multidisciplinary team to ensure effective and consistent client care planning and delivery; ensures care planning information and/or significant clinical changes is communicated to the client, family and members of the multidisciplinary team.
- Advocates for system/program changes that will enhance the capacity to support the client/ family/caregiver; demonstrates skills in using a systems perspective to plan, organize and establish priorities and to use resources more effectively and efficiently.
- Provides input in the development and revision of standards of care, policie