The Champlain Local Health Integration Network’s (LHIN) mandate is to ensure health services are well-organized, appropriately funded, and meet the health needs of the 1.3 million residents who call this region home.
We work with and fund roughly 120 health service providers that offer about 240 health programs in hospitals, community support services, mental health and addiction services, community health centres, and long-term care homes. The Champlain LHIN also delivers home and community care services.
The Care Coordinator, Palliative Care is responsible for, or supports other Care Coordinators in managing, a caseload of palliative patients who are at different stages of illness trajectories and may require a palliative approach to care. The Care Coordinator, through home visits and/or phone conversations, measures the patient’s and caregiver’s care needs and develops, implements, and updates (as required) a care plan that is informed by the patient’s and caregiver’s wishes and preferences. He/she assists the patient and caregiver in navigating the health care system and also determines eligibility and refers to other community resources and programs, such as Hospice care and the Regional Palliative Consultation Team.
Education and Experience:
- Completes comprehensive patient assessments using a validated palliative assessment tool, including patient’s clinical, physical and psychosocial needs, and caregiver needs
- Assesses patient’s Palliative Performance Scale and eligibility for palliative and other services
- Assesses eligibility for hospice care and admission to palliative care units
- Develops an individualized care and service plan reflective of the patient’s identified priorities and desired outcomes; identifies strategies and resources to be used in attaining clinical outcomes
- Discusses plans for end-of-life care, goals of care and preferred place of death
- Coordinates and facilitates referrals and transfers to hospice and palliative care units
- Assists patients and caregivers in finding in-home palliative medical follow up and coverage
- Initiates and authorizes the implementation of the care plan through contracted providers, supplies and equipment necessary to achieve the care goals
- Maintains open communication with service providers, conducts case conferences and regular home visits to optimize care planning and appropriate services
- Partners with the LHIN/Ottawa Hospital Medical Assistance in Dying (MAiD) Care Coordinator for those clients wanting and requiring assistance with MAiD.
- Registered Nurse (BScN or diploma) with a current Certificate of Registration from the College of Nurses of Ontario
- Related professional nursing experience which is normally attained over a period of two years
- Palliative care experience that includes advance care planning, goals of care and end of life care planning
- Professional experience in health care should include linkage with other community health agencies, needs assessment, care coordination and/or discharge planning
- Canadian Nurses Association Certification in Hospice Palliative Care is an asset
- LEAP training is an asset
- Experience providing MAiD expertise are assets
Skills and Abilities:
- Knowledge of medical diagnoses and prognoses, symptom management, end-of-life care and cognitive/psychiatric disorders
- Knowledge of Champlain region Hospice and palliative care organizations and partners
- Knowledge of Hospice palliative care philosophy and approach
- Working knowledge of computer software (email, internet) and Microsoft Office applications (Word, Excel, Power Point, etc.)
- Effective planning, organizing, and evaluation skills to manage multiple patients, provide information reports, and take corrective action as required
- Ability to accurately complete required documentation, reports, forms, and recommendations
- Verbal and written communication skills to establish and maintain a wide range of partners (doctors, nurses, social workers, etc.) within the healthcare and Hospice community
- Ability to manages difficult conversations /situations such as advance care planning, goals of care, end-of-life and hospice care, and medical assistance in dying, in a healthy and effective manner
- Fluency in English and French is required.
- Vulnerable Sector Check completed within the last six months
Wages are in accordance with the collective agreement between Champlain LHIN and OPSEU and starting salaries range from $39.22/hr. - $41.89/hr.
Monday to Friday, 8:30am to 4:30pm
709 Cotton Mill st, Cornwall, Ontario
This position is temporary until approximately December, 2021.
Please note that selection will be in accordance with Article 12.02 of the Collective Agreement (Selection).
All applications will be reviewed; however, only those selected for an interview will be contacted.
Champlain LHIN welcomes and encourages applications from people with disabilities. Accommodations are available on request for candidates taking part in any aspects of the selection process.