By: Devon Rocha, MSW, LSW
Mr. Jones arrives at the same time every Monday, Wednesday, and Friday, at 8:30 a.m. sharp. He nods good morning to the same familiar faces, exchanging words about the weather and the price of gas. He gets himself a cup of coffee before taking his seat, where he will be stationed for the next four hours. He has been doing this routine for the past two years, and will continue to do so for the rest of his life. At 68 years old, he has a lifetime of hard work behind him and was able to retire.
Yet, during his “golden” years when he would like to be traveling, taking care of his grandchildren, and working in his garden, a substantial portion of his week is tied up for him to receive life-sustaining kidney dialysis treatments. He is almost literally tied up during this time, too, with one arm wrapped in a blood pressure cuff and the other arm stuck with needles to accommodate the cycling of blood in and out of his body, getting cleaned. Mr. Jones must attend his treatments regularly like this because his kidneys do not work as they should. This leaves fluid and toxins in his body that need to be removed, or he will die.
Nephrology (dialysis) social work is within the realm of medical social work but is very unique. The patients vary in age and degree of physical health, come from diverse backgrounds, and have a vast array of need. The work in this setting is both highly rewarding and very challenging.
There are several treatment options for kidney failure, or end stage renal disease. Patients can try to receive a kidney transplant, they can do dialysis at home, or they can go to a clinic for dialysis treatments. I work for a clinic where people come in to receive their dialysis treatments, like Mr. Jones in the above example. The dialysis population I work with encompasses an age range of 29-93, with the majority of these patients in their 50s to 60s. The independently owned clinic where I work is located on the west side of Chicago. The majority of dialysis clinics are owned by one of a few large corporate chains. Our census typically hovers around 85 patients at any given time. It changes with new admissions, the occasional (and very sad) patient death, the even less frequent occurrence of a patient receiving a kidney transplant, and the sometimes extended hospitalization that leads to discharge from the patient schedule.
Per Medicare regulations, every dialysis clinic is required to have a licensed, master’s level social worker on staff as part of an interdisciplinary team. The other team members are the doctor, nurse, dietician, patient care technician, and the patient. Each person brings to the table a unique perspective to help ensure that the patient receives proper care. This is helpful because there is always someone to consult with if a concern comes up about a patient. For example, a patient presenting with depressive symptoms such as poor appetite, insomnia, and lethargy could also indicate a problem with uremia, which is a buildup of toxins in the body. This can happen when the patient does not get “enough” dialysis. The nurse, doctor, dietician, and social worker each contribute from their own foundation of knowledge to the care of the patient, creating a very holistic approach to treatment. The patient, in turn, feeds back to everyone how he or she feels, if there are any concerns about his or her healthcare, and if there are any difficulties in reaching treatment goals.
This team approach starts by undertaking a comprehensive interdisciplinary assessment and developing a plan of care upon the patient’s admission to the clinic. The psychosocial portion of this assessment is extensive and covers the planning of healthcare advance directives; taking a mental health history; exploring the available support system; and discussing interests, hobbies, or vocational goals.
I get to do a lot of one-on-one supportive counseling regarding various issues, from managing feelings of depression regarding chronic illness to adjusting to life role changes. However, the majority of my time is actually spent on very “practical” assistance, like completing and following up referrals for community resources such as in-home services, assisting patients with insurance problems or issues, and identifying affordable housing resources.