“Social Worker” is a person who has graduated with a masters degree from a graduate school of social work accredited by the Council on Social Work Education.

As follow up to my previous posts about “Dialysis and Depression“, I spoke with a social worker who been at the same location for about 15 years.  We talked about Dialysis and Social Work and what it’s like from her perspective.  She remarked about how things have changed a lot over the years.  When she started, she had one center, could spend 40 hours a week talking to one group of patients and get to know them well enough that “it was one big family”.  That’s no longer the case.  She now has 3 centers and is spread among them and their patients such that she barely has time to get to know many of the patients. The routine is intake, paper pushing, and discharge with little in between.

As a social worker, interaction is extremely important.  They must spend time with each patient building a relationship.  Since that doesn’t seem to be the case anymore, they make use of any tools available such as the KDQOL (Kidney Disease Quality of Life) test from the Renal Network.  The KDQOL is a questionnaire to assess the quality of life for dialysis patients.  I’ve taken it twice and the first time I scored slightly in a dangerous zone indicating depression and suicidal.  The social worker was contacted and she immediately came to me to discuss it.  I explained to her that I simply answered the questions honestly and she confessed that I was the last person she expected to score as I did.  The second time I scored a little higher on the scale to her great relief since I was no longer on the edge of depression or suicidal.

The social worker I interviewed pointed out that too often patients don’t answer the questionnaire carefully or honestly or even fully.  As a result, the KDQOL cannot be a good measure for the “quality of life”.  It needs honest answers and should be fully completed.  But all that can be done anymore is to give the patient the questionnaire and hope for the best.

This hardly seems adequate for the emotional health of dialysis patients!  A patient load that is overwhelming a single person trying to cover three shifts of patients in three centers?  If there are 15 patients per shift per center, that works out to 135 patients!  How is one person able to build an on-going relationship with 135 people at three different centers from 6 am to 9pm in a 40 hour week along with the stack of paperwork that must be completed and submitted?! It’s impossible.

Cutbacks are the main reason for such high patient ratios.  Social work in the dialysis setting is often viewed as a “luxury”.  I’ve spoken with other patients and some claim their centers don’t even have a social worker.  Since it’s required by Medicare, I’m sure the center has one but they are probably pro forma and so spread out they are rarely seen by patients and vice verse   The law only states that the center must have one “on staff” but not what they are to do and what the patient load is supposed to be. There’s the ideal and there’s the reality and all too often they don’t even come close to each other.  I suspect when the law was written “on staff” meant one social worker per center.  But give a CFO a penny and he/she will take a dollar.  Spreading one person over several centers became “on staff”.

As a patient who’s needed the social worker to help me through the emotional lows associated with dialysis, I’m concerned about the providers viewing that tole with so little regard.  They shouldn’t be spread out so thin and unable to perform their jobs.  Medicare needs to review this role in the treatment team and give it the same validity as they do the other team members.  Where the tech is limited to a patient load, so should the Social Worker.  Their case load should is regulated but there are loopholes.  Here in Texas, there is a legal patient load limit:

The governing body shall ensure that personnel shall be assigned to assist a social worker(s) with ancillary tasks (e.g., assistance with financial services, transportation, administrative, clerical, etc.), when the patient load, including all modalities, exceeds 100 patients per facility. The maximum patient load, including all modalities, per full-time equivalent qualified social worker, with assigned personnel assistance, is 125 patients. (TX Admin Code)

However, it doesn’t say how many centers the person can be assigned to or how many hours per week per center in the case of multiple centers.  There’s a lot left out of this requirement and who’s counting?! As long as a provider can show the total case load is less than 125, they probably get away with “those details”.

When the Social Worker is overloaded, the patients suffer.  For example, I need help to find housing.  All social worker could do was hand me a multi-page copy of a document with names, addresses and phone numbers so I could go through it myself. She didn’t have time to sit down with me to discuss the matter and give me advice on how to proceed.  I don’t blame her, I blame the center’s operator.  She is too overloaded and stretched too thin and the patients lose out on that. Something needs to change.

DevonTexas © 2012