Did you know that March is not only National Kidney Month, but Social
Work Month as well? The 120,000 member National Association of Social
Workers (NASW) collaborated with Rob Lowe on a mini-documentary to
promote mental wellness and encourage greater access to
behavioral health services in healthcare settings.
Kidney disease is unique in that the federal government
recognized the importance of addressing mental wellness in
dialysis. The ESRD Conditions for Coverage (CfC) REQUIRE every
dialysis clinic and every transplant program to provide patients access
to a social worker with a master’s degree in social work who is
licensed, if required, in the state where they practice. Dialysis social
workers participate on an interdisciplinary team (IDT) that also
includes the patient, physician, nurse, and dietitian. Under the ESRD
CfC at 42 CFR 494.80(a)(7), social workers are explicitly charged with
assessing the “psychosocial needs” of all the dialysis clinic’s
patients. According to the World Health Organization 30-55% of
health outcomes are related to SDH. On its website,
it defines SDH this way:
“The social determinants of health (SDH) are the
non-medical factors that influence health outcomes.
They are the conditions in which people are born, grow, work, live, and
age, and the wider set of forces and systems shaping the conditions of
daily life…“The following list provides examples of the social
determinants of health, which can influence health equity in positive
and negative ways:
-
Income
and social protection -
Education
-
Unemployment and job insecurity
-
Working life conditions
-
Food insecurity
-
Housing, basic amenities and the environment
-
Early childhood development
-
Social inclusion and non-discrimination
-
Structural conflict
-
Access to affordable health services of decent quality.”
Nephrology
social workers have known this for decades. The Interpretive
Guidance (IG) to the ESRD CfC lists some but not all of the
areas that social workers assess:
- Cognitive status and capacity to understand
- Ability to meet basic needs
- Ability to follow the treatment prescription
- Mental health history, capacities, and needs for
counseling - Substance abuse history, if any
- Current ability to cope with and adjust to dialysis
- Expectations for the future and living with kidney failure and
treatment - Educational and employment status, concerns, and goals
- Home environment including current living situation
- Legal issues (e.g., court appointed guardian, advance directive
status, and health care proxy) - Need for advocacy with traditional (nursing home) and
non-traditional housing (e.g., homeless shelters, group homes) - Financial capabilities and resources
- Access to available community resources
- Eligibility for Federal, State, or local resources
Besides clinical areas, the IDT is to assess “the patient’s
abilities, interests, preferences, and goals, including the
desired level of participation in the dialysis care process;
the preferred modality (hemodialysis or peritoneal dialysis), and
setting, (for example, home dialysis), and the patient’s expectations
for care outcomes.” The IG requires the staff to evaluate and
consider self-care training for patients who want to monitor
their weight, BP, hold their needle sites or self-cannulate.
Self-cannulation can be a steppingstone to in-center self-care or home
HD. The social worker can also assist the IDT assessment by evaluating
the patient’s support system and need for vocational and/or physical
rehabilitation.
Once the IDT has completed its assessment, the next step is for the
professional members of the IDT to collaborate closely with the
patient on a plan of care that addresses his or her individual
needs. Social workers take the lead on the plan for
“psychosocial needs” [42 CFR 494.90(a)(6)]. They can provide counseling
to help patients (home and in-center) “achieve and sustain an
appropriate psychosocial status” and to identify problems related to
patients’ health-related quality of life (HRQOL). Social workers ask
patients to complete (with or without help) a validated survey such as
the PedsQL for those under age 18
or the KDQOL-36 for those 18 and older. The KDQOL-36’s five domains
include physical functioning, mental functioning, symptoms/problems,
burden of kidney disease, and effects of kidney disease on daily
life.
Medical Education Institute (MEI) developed KDQOL Complete (KC)
to help clinics score and analyze survey results, generate a report to
inform the patient’s Plan of Care, and provide patients with suggested
ways to improve their scores. KC also provides multiple clinic reports
the IDT can use for quality assessment and performance improvement
(QAPI) meetings. It monitors how many patients completed surveys for the
month and year vs. the prior year, survey refusals and exclusions,
demographic and treatment data, plus the HRQOL status by domain of all
of the clinic’s patients surveyed.
Discussing scores and goals with patients and reviewing their answers
to individual questions within each domain can help the IDT plan how to
maintain scores that are average or above while addressing below average
scores. This is important because more than two decades ago,
research found that dialysis patients are at greater risk for
hospitalization and death if they have low HRQOL scores. Social workers who used Symptom
Targeted Intervention (STI) techniques and tools reduced depression and
improved HRQOL.
Patients who do in-center dialysis may see their social worker
regularly. But those who dialyze at home may not be aware of all the
ways their social worker can help them. The National Kidney
Foundation (NKF) published a fact sheet that social
workers can share with those on in-center and home dialysis to make sure
they know the social worker’s role. Although social workers do
help those who do dialysis to understand options to pay for
dialysis-related expenses and how to access financial resources, they do
much more, such as:
- Counseling to help patients and families—including care
partners—to cope with kidney disease and dialysis - Patient referrals (with MD orders) for home health and physical
rehabilitation - Encouraging patients to stay engaged with their friends,
families, and communities - Helping patients identify and work toward vocational goals, with
referrals as needed - Helping to address conflicts, complaints, and grievances
- Serving as the patient’s advocate with the IDT; and much
more
Social workers are invaluable members of the IDT. They help the rest
of the IDT to educate and support all patients, including those on home
dialysis. Social work interventions empower patients to work
toward achieving their goals. Dialysis social work is
not an easy job, with large numbers of patients and limited time to meet
their needs, however for many long-term dialysis social workers, it is a
calling. This March during Social Work Month, I call upon all
dialysis patients and staff to make a special effort to thank your
social worker for all s/he does.
- The Renal Warrior Project. Join Now
- Source: https://homedialysis.org/news-and-research/blog/589-march-is-kidney-month-and-social-work-month