The Home Based Primary Care (HBPC) Social Worker is part of a multidisciplinary treatment team that collaborates with team members, Veterans, and family/caregiver in developing and implementing care. The incumbent works with team to provide comprehensive, interdisciplinary primary care services in the homes of Veterans with complex, chronic, and disabling disease. In addition to primary care interventions, HBPC provides palliative care, rehabilitation, disease management, and care coordination. The Social Worker engages the Veteran and their support system in a therapeutic relationship to facilitate optimal level of functioning in a home care setting. In cases where this may not be possible, the Social Worker provides education and assistance in linking the Veteran with community settings
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