Throughout the years the role of the social worker in the dialysis unit has changed and evolved but one fact remains constant and that is social workers are essential to the well being of patients and their adjustment to the world of dialysis. Social workers are highly trained individuals and Centers for Medicare and Medicaid Services requires each dialysis facility to employ a social worker with a master’s degree from a college or university that is accredited by the Council on Social Work Education. Renal social workers serve as a support system for you and your family in adjusting to and understanding end stage renal disease (ESRD). Being told you have ESRD is understandably challenging and overwhelming; this is when the services of a social worker are imperative. Your social worker is your advocate, and serves as a bridge in communicating your needs to the treatment team members, which consist of the nephrologist, nurses, dietitian, social worker and, of course, the most important person, you.
Responsibilities of the Social Worker:
When you begin dialysis there are various staff members speaking with you and asking questions, and one of those people is your social worker. Your social worker is required to complete an initial assessment with you within the first 30 days of admission to your facility. During this assessment you will be asked numerous questions about a variety of topics, which include:
- Family and other support systems
- Current activities and limitations
- Financial and insurance information
- Medical history
- Emotional health
- Mental health or substance abuse concerns
- Physical abilities
- Preference in treatment modality
- Legal documentation such as advanced directives
- Education and work history.
At times this can be difficult for new patients who are in the process of adjusting to dialysis, but this is your social worker’s method of establishing a relationship and treatment plan with you to address any needs you may have presently or in the future. In order for your social worker to understand your needs, you must be honest and willing to answer difficult, and at times, uncomfortable questions.
In 2008, social workers were required to begin administering a quality of life survey annually to patients. The quality of life survey utilized is the KDQOL-36 and is given to you to complete. It may appear this is something extra that is required, but it provides your treatment team with a picture of your health from your point of view and helps the treatment team understand how dialysis impacts your daily life. The survey helps the team provide better care to you by identifying and addressing areas that you feel are important. By completing this survey annually you are able to monitor your progress and determine the areas that have improved or need more attention.
In addition to assisting patients with learning how to cope with kidney disease and adjusting to the life changes of dialysis, other social worker responsibilities include:
- Evaluating for vocational rehabilitation services which includes employment, going to school, volunteering within the community, or returning to previously enjoyed activities
- Providing education and referrals to appropriate resources
- Assisting with keeping or obtaining insurance coverage
- Assisting patients with understanding their rights and responsibilities
- Providing supportive counseling
- Assisting in informing patients of the importance of treatment participation
- Advanced Directives education.
Your social worker will meet with you to discuss your interdisciplinary care plans and get your input. Annually you will meet to complete your psychosocial assessment. This will determine your strengths, reevaluate any needs and identify and plan future goals. During the process your participation and collaboration with the treatment team is essential in making it successful and helpful to your needs.
Communicating With Your Social Worker
A majority of renal social workers provide services at more than one dialysis unit. At times it may appear the social worker is not at your unit when you need his/her assistance. In order to ensure you get all your questions or concerns addressed, try making a list of the questions you need to ask. Then when the social worker is visiting with you, discuss the concerns on your list. Unforeseen situations may also occur and you need assistance. If you need to speak with your social worker and he/she is not present, ask the facility staff when the social worker will be present or if your situation is urgent, ask them to contact the social worker.
What is My Role as a Patient?
The patient’s role is the most important one in this entire process. You may not have control of your treatment schedule or the temperature of the dialysis unit, but you do have control over the amount of effort you put into your care. Your social worker is an educated resource for addressing dialysis questions if you choose to utilize his/her expertise. When speaking with the social worker, be clear and precise and be willing to ask for help. Remember, your social worker does not know you need help unless you ask for it. You must accept your responsibilities and be agreeable to working with your social worker as a team. Be willing to accept guidance and do as much as possible independently, but don’t be afraid to ask for help when you need it. Your social worker is a resource to help you identify your strengths and utilize those to successfully cope with the life changes of ESRD.
NaTasha Avery, LMSW, is the Patient Services Coordinator for Network 8, Inc. serving the renal community of Alabama, Mississippi and Tennessee. She received her bachelor’s degree from Mississippi State University and a master’s degree in social work from Jackson State University. She has presented at numerous professional and patient workshops throughout the region. She is also a member of the Mississippi Kidney Foundation’s Professional Advisory Board.
This article originally appeared in the May 2010 issue of aakpRENALIFE.