Medical Social Worker Home Health


Job Title/Position: Social Worker

Reports To: Clinical Supervisor or Master of Social Work


The social worker contracted or employed through the organization is responsible for the

implementation of standards of care for medical social work services and for adherence to all

conditions in the Service or Employment Agreement which include providing care based on the

Social Work Practice Act.


1. Assesses the psychosocial status of patients and families/caregivers related to the patient's

terminal illness and environment and communicates findings to the registered nurse and

other members of the interdisciplinary group. Provides an assessment in the patient's

identified residence and assistance when this is not safe and another plan is required.

2. Carries out social evaluations, including family dynamics, caregiver abilities,

communication patterns, high-risks for suicide, neglect or abuse and plans intervention

based on evaluation findings. Counsels patient and family/caregivers as needed in

relationship to stress, and other identified coping difficulties. Provides crisis intervention

when necessary.

3. Assesses for, and educates interdisciplinary group, on any special needs related to the

culture of the patient and family. Includes communication, role of family, space, and any

special traditions or taboos.

4. Maintains clinical records on all patients referred to social work prepares clinical and

progress notes.

5. Educates patients and families on, and assists in, preparation of advanced directives.

6. Provides information and referral services for organization patients and families/caregivers

regarding practical and environmental needs.

7. Provides information to patients and families/caregivers and community agencies.

8. Serves as liaison between patients and families/caregivers and community agencies.

9. Maintains collaborative relationships with organization personnel to support patient care.

10. Maintains and develops contracts with public and private agencies as resources for patient

and personnel.

11. Participates in the development of the individualized plan of care, involving the patient and

family, and attends regularly scheduled interdisciplinary group meetings, assisting the team

in recognizing the effects of the psychosocial stresses on the symptoms of the terminal


12. Assists physician and other team members in understanding significant social and emotional

factors related to health problems and death/dying issues.

13. Actively participates in quality assessment performance improvement teams and activities.

14. Assists family and patient in planning for funeral arrangements, financial, legal, and health

care decision responsibilities.

15. Other duties as delegated by the Clinical Supervisor.

The above statements are only meant to be a representative summary of the major duties and

responsibilities performed by incumbents of this job. The incumbents may be requested to

perform job related tasks other than those stated in this description.


1. A graduate of a bachelor’s program in social work accredited by the Council on

Social Work Education. Meets personnel qualifications stated in §418.114(b)(3).

2. Minimum of one (1) year's experience in health care, hospice experience preferred.

Understands hospice philosophy, and issues of death/dying.

3. Experience in a hospice care preferred.

4. Demonstrates good verbal and written communication, and organization skills.

5. Possesses and maintains current CPR Certification.

6. Must be licensed with an automobile that is insured in accordance with state and/or

organization requirements and is in good working order.