Social Support Services

The Vendor is required to provide social support services available to ensure resident health, well-being and related quality of life needs and wishes are identified, enhanced and maintained according to the resident and substitute decision maker.
- Social support services for one or more than one home.
- Requirement:
• Provide on-site individualized resident assessment, psychological and holistic support and counseling for residents on an as needed basis;
• Provide support during the admission, residency and discharge phase as requested;
• Conduct initial assessment of resident, proposed interventions and progress in treatment and document as required using the homes' electronic documentation record;
• Social support services worker is expected to respond with a plan of action within 24 -48 hours of being notified;
• Provide consultation and intervention to residents and family members as requested to ensure resident health and well-being and quality of life goals are identified, enhanced and maintained
• Identify appropriate intervention and discharge plan and document in the resident's electronic care plan
• Indicate specific goals with timelines and document in the residents' electronic care plan;
• Assess, plan, implement and evaluate goals identified by the resident and substitute decision maker;
• Coordinate and liaise with community services, identify and promote additional community services that may enhance the health, well-being and quality of life for the resident and family member
• Maintain a profile on each resident referred.
• All documentation to be maintained in the resident's permanent record and recorded in the electronic multi-disciplinary progress notes;
• Liaise with the long-term care homes manager of resident care and resident and substitute decision maker in developing a proactive plan of care to ensure ongoing resident and family satisfaction;
• Discuss ongoing case files and strategies with the manager of resident care and administrator of the home;
• Attend multi-disciplinary care conferences as requested;
• At the end of each month, invoices itemizing all services (including the resident's name) to be provided to county homes in accordance with an established fee schedule.