Senior Social Worker-Home Based Primary Care

Department of Veterans Affairs

The Miami VA Healthcare System (Bruce W. Carter VA Medical Center) Social Work Service is seeking an experienced and dynamic Senior Social Worker-Home Based Primary Care. Ideal applicants are those who want to contribute to the achievement of quality care standards, as well as the growth and development of a VA academic hospital program. You must be an excellent communicator and team player who is adaptable to the needs of a growing medical center.

• VA offers a comprehensive total rewards package. VHA Total Rewards. Pay: Competitive salary, annual performance bonus, regular salary increases Paid Time Off: 50-55 days of paid time off per year (26 days of annual leave, 13 days of sick leave, 11 paid Federal holidays per year and possible 5 day paid absence for CME) Retirement: Traditional federal pension (5 years vesting) and federal 401K with up to 5% in contributions by VA Insurance: Federal health/vision/dental/term life/long-term care (many federal insurance programs can be carried into retirement) Licensure: 1 full and unrestricted license from any US State or territory CME: Possible $1,000 per year reimbursement (must be full-time with board certification) Malpractice: Free liability protection with tail coverage provided Contract: No Physician Employment Contract and no significant restriction on moonlighting Functional Statement #: #31780F A senior social worker in home-based primary care plays a central role in supporting older adults and their families by addressing both medical and psychosocial needs. Their work is often collaborative, involving coordination with healthcare providers, caregivers, and community resources. In home-based primary care, the senior social worker's role is to bridge gaps between medical treatment and daily living, ensuring that seniors receive safe, coordinated, and person-centered support in their own homes. This requires strong communication, empathy, and organizational skills, as well as the ability to adapt to the unique needs of older adults and their families. Duties and responsibilities include, but are not limited to: Evaluate the senior's physical, emotional, social, and financial needs through home visits and interviews. Identify strengths, limitations, and risk factors to inform care planning. Develop individualized care plans that integrate medical, social, and emotional support. Set measurable goals for recovery, independence, and quality of life. Connect seniors with home health care, therapy, transportation, and other community resources. Liaise with physicians, nurses, therapists, and home care agencies to ensure continuity of care. Provide individual and family counseling to address grief, anxiety, depression, or adjustment challenges Offer crisis intervention when necessary. Educate seniors and families about aging-related issues, available programs, and self-care strategies Conduct regular home visits to monitor progress, adjust care plans, and address emerging needs. Assist in transitioning seniors from hospitals or rehabilitation centers to home care, ensuring safety and readiness Work Schedule: Monday - Friday, 8:00 am - 4:30 pm (Note: Work schedules are determined and approved by the supervisor. The incumbent may be required to work various shifts on a permanent or temporary basis based on facility/patient care needs).

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