The HBPC program is a unique model of home care designed to serve the chronically ill through the months and years before death, providing needed long-term care services in the home. The HBPC model targets persons with complex chronic diseases that worsen over time and provides interdisciplinary care that is longitudinal and comprehensive rather than episodic and focused.The HBPC SW has 2 openings: Prestonsburg CBOC and Huntington, WV. The Social Worker assigned to the Home Based Primary Care (HBPC) program will be a member of an interdisciplinary team to meet the overall medical and psychosocial needs of the Veteran. Duties may include but are not limited to the following: Independently visit Veterans in their homes and must use a high level of skill in assessing and treating the complicated psychosocial problems of Veterans; Assessments of psychosocial problems often at a time when the Veteran is experiencing crisis and include the provision of short-term, solution focused counseling with Veterans and/or their families; Case management with members of the HBPC interdisciplinary team is provided in order to coordinate a collaborative effort to meet the agreed upon goals for a Veteran's treatment needs and include liaison with community professionals regarding needed services for Veterans and/or their families; Serve as a liaison between Veterans and/or their families and VA and community resources in order to ensure thorough delivery ofservices; Provide consultation and education to Veterans and their families regarding community resources, VA benefits and specialty programs, and advance directives; Coordinate discharge planning for HBPC patients; Accept and perform other duties as assigned; Provide Telehealth services as indicated; Work Schedule: Compressed Tour of Four 10 hour days Compressed/Flexible: Available Telework: Available Virtual: This is not a virtual position. Relocation/Recruitment Incentives: Not authorized Permanent Change of Station (PCS): Not authorized Financial Disclosure Report: Not required
Providing Health Care for Veterans: The Veterans Health Administration is America’s largest integrated health care system, providing care at 1,255 health care facilities, including 170 medical centers and 1,074 outpatient sites of care of varying complexity (VHA outpatient clinics), serving 9 million enrolled Veterans each year.