About SPRINT Senior Care:

We began caring for seniors and enabling seniors to care for themselves in 1983. We continue to do so today as an accredited, not-for-profit community support service agency in Toronto by offering a wide range of practical and low-cost services to seniors and their caregivers. Our services help seniors stay safe, connected, and live as independently as possible.

Program Description:

Sunnybrook to-Home is a collaborative partnership with Sunnybrook Hospital and designed service providers. The client-centred initiative enables timely and seamless transitions home from hospital, and provides integrated, comprehensive care in the home or community. The initiative aims to reduce emergency visits to hospitals and hospital length of stay; enhance the care experience of clients, family, and caregivers; and develop a new model of healthcare tosupport clients in receiving the right care in their own homes.

The Transitional Care Lead acts as the primary linkage between the client(s) and the hospital and home care teams. A key component of the position is coordinating home care services through the Service Provider Organization partner and building a network of community resources that strengthen client independence, dignity and self-respect within a safe community environment.

What you will do:

- Provide leadership and client centred navigation including case management, and coordination of hospital, home care and community services.
- Identify eligible clients in collaboration with hospital social workers, discharge planners and other Transitional Care Leads.
- Act as liaison between clients, the hospital team, and home and community care providers, to ensure seamless post discharge care.
- Conduct ongoing assessment and adapt care plans collaboratively with the clinical teams, families and caregivers, and home care providers.
- Develop transitional plans that support reintegration back to the community.
- Connect clients to community support services in collaboration with clients, families, caregivers and home care teams.
- Provide leadership and coaching to care team members, including other transitional care leads and home and community partners.




- Monitor program objectives and collaborate with Sunnybrook-to-Home team to ensure that the client and system level objectives are met.
- Supportive program development through data collection, metrics and client care statistical tracking.
- Provide coverage for other Transitional Care Leads as needed.
- Supervise assigned staff and support managing the Transitional Care department.
- Lead partnerships activities with Sunnybrook Health Sciences Centre and establish new community partnerships.
- Maintain collaborative relationships with referral sources and resources.
- Participate in the development, implementation and evaluation of quality and risk management activities of the department and agency.
- Ensure that the agency’s programs and services are delivered within the agency’s mandate, mission, vision and values, objectives, and policies and procedures, within relevant legislative requirements.
- Off hours may be occasional required based on client needs. Ability to work flexible hours as required.

What you will need:

- BSW or greater, or other related professional designation.
- Minimum of two years of experience working in gerontology and/or community setting.
- Strong supervisory skills.
- Excellent communication and interpersonal skills, with the ability to establish good rapport with staff, clients, families, and referral sources in a multi-cultural setting.
- Excellent understanding of the aging process, dementia and the specific needs of the elderly, disabled and caregivers.
- Experience working with individual caregivers.
- Sensitive to the cultural needs of clients from various ethnic groups.
- Committed to SPRINT Senior Care's philosophy of care, with the ability and empathy to work with all client populations especially frail and medically complex, people with dementia,



and mental health and addictions.
- Self-directed, results oriented and capable of working independently as well as in a team setting.
- Excellent leadership, organizational, facilitation, conceptual, strategic, and problem solving skills.
- Excellent knowledge of program evaluation, risk management and quality improvement strategies.
- Proven ability to establish and maintain productive working relationships internally and externally with stakeholders and partnering agencies.
- Demonstrates computer skills at an intermediate or higher level for the use of the Internet and the following Microsoft Office applications: Word, PowerPoint, Publisher, Excel and Outlook. Demonstrates an intermediate level for database concepts and structures.
- Familiarity AlayaCare database is an asset.
- Ability to work both independently and collaboratively within a team.
- Demonstrated commitment to ongoing professional development.

Our Caring Workplace Working at SPRINT Senior Care, you'll have the opportunity to be a part of a passionate team committed to providing client-centred, high quality services to seniors in our service area.

SPRINT Senior Care’s inclusive environment is one of many benefits for staff, including SPRINT Senior Care’s dedication to staff wellness, a comprehensive benefits package for eligible employees, and comprehensive training and tuition reimbursement programs.

SPRINT Senior Care is committed to inclusive and accessible recruitment practices in accordance with the Ontario Human Rights Code and the Accessibility for Ontarians with Disability Act (AODA). Reasonable accommodations are available on request for candidates with disabilities taking part in all aspects of the selection process.

Job Types: Full-time, Permanent

Pay: $36.53 per hour

Perks

- Dental care
- Extended health care
- Life insurance

Ability to commute/relocate:
- Toronto, ON: reliably commute or plan to relocate before starting work (required)

Education:
- Bachelor's Degree (required)

Experience:
- gerontology /community setting: 2 years (required)
- supervisory: 2 years (required)

Work Location: In person

📌 Transitional Care Lead (Toronto)
🏢 SPRINT Senior Care
📍 Toronto