Directs and monitors the social work services in the centerAssess residents' psychological status during admissions, knowledgeable in PASSRS, MDS, Annuals, and Quarterlies during their residency.Works directly with the resident, family, and interdisciplinary team members to outline the goals of staying at admission and create a plan to meet those goals.Discusses with resident and family members/responsible party regarding advance directives.Conducts discharges planning, behavior, and care plan meetings.Works closely with community resources such as Home Health agency, Hospice, Aging Services Access Points (elderly services) to ensure resources are available as needed per discharge plan.

• Provided case management coverage for various departments at BSHC, including Home Care Programs, Senior Care Options and Adult Foster Care and Group Adult Foster Program• Through home visits conduct multi-dimensional assessment of elders’ functional and social needs incorporating eligibility/need for services, special programs and other community resources • Conferred case and worked closely with a group of providers, including physicians and nurse practitioner to coordinate and implement service plan• Maintained progress notes and up to date information relating to client records

• Provided interpretation and translation services for non-English speaking patients at various departments in B.I.D.M.C.• Translated consent forms and other written materials for procedures• Interpreted during procedures and surgeries, e.g. endoscopy, colonscopy, cardiac catherization, cataract surgery, labor & delivery, C-section, etc.• Relayed patient-provider communications and provided administrative assistance when needed• Explained cultural differences to providers and patients when needed• Performed on-call responsibilities