Responsibilities

Collaborates with the health care team on all aspects of service delivery;

Receives and sends referrals, conducts nursing assessments and creates care plans to meet client needs and follow treatment orders;

Works with the health team to develop a client work plan where required that promotes the client and family ability to function at the highest level of independence possible;

Completes referrals for clients requiring additional services;

Advocacy role for clients to community and institution-based services;

Performs nursing tasks as required in the client’s home that are in line with the Home and Community Care Program

Performs nursing assessments on new and continuing clients (at minimum yearly);

Coordinates case management with client, family, and other service providers;

Provides interdisciplinary, needs-based palliative care to clients;

Direct supervisor for the Home Support ...