By JENNIFER L. ROWE, MSW, LCSW
When the world shut down, people were advised to stay home. Restaurants, travel, schools, medical offices, and other settings closed. Now, imagine being a patient on life-sustaining, in-center hemodialysis who must attend treatment three times a week: Your choices are dialysis or death. “Centers for Disease Control and Prevention recommendations early in the pandemic were scarce and difficult to follow. Those who required in-center dialysis did not have the option to stay at home, as treatments require going to a center for care, typically three times a week for four hours” (Schiller & Dittrich, 2022).
Part of the uncertainty for dialysis patients was hearing news stories about who was at the highest risk for COVID-19 and learning they were among the groups at highest risk (Schiller & Dittrich, 2022). Dialysis patients had to weigh their choices. How do you stay safe? What are your options when your usual transportation is a vendor who refuses to transport you? How do you get to your dialysis treatment? What do you do when those volunteer agencies your social worker relies on to assist you have stopped services? Home care agencies cannot accommodate you if you need a home health aide due to severe staffing shortages. Add to this the dialysis clinic staff member, who knows you best, cannot care for you, as another clinic is designated as the COVID-19 centralized care clinic.
While all of this sounds like gloom and doom, there was an upside to the challenges outlined here. Across the world, communities were rebuilt in different ways. Dialysis patients began to carpool, family members drove loved ones, and families were home to be caregivers. Agencies revised policies to train and hire families as paid caregivers.
One area of dialysis community growth was in-home dialysis, in which a patient has home hemodialysis, or peritoneal dialysis, from the comfort of their home. This option meant that patients could remain safe at home during COVID restrictions and reduce contact with others. Many renal patients hadn’t considered dialysis at home before the pandemic but were now more open to switching to a home setting (Northern Health, 2020). The interdisciplinary teams, of which social workers are an integral part, adjusted to either a telehealth model or visiting patients’ homes instead of patients entering the clinic. As Schiller and Dittrich (2022) noted, “We adopted telehealth visits, allowing patients to remain at home or to see their physicians virtually. For dialysis patients who were candidates for home dialysis, our physicians and staff helped with education and getting those interested set up with dialysis in the home.” In several clinics social workers set up virtual groups to connect home dialysis patients with one another, promoting a sense of connection and community.
In New York City, the New York Times Neediest Cases Fund profiled specific residents and was able to assist via various programs. One recipient was a dialysis patient: In January 2020, Mr. [Robert] Sanchez had a cancerous kidney removed, and as he recovered, the pandemic began, requiring him to isolate vigilantly to protect his health. The pandemic also delayed a kidney transplant, his second such procedure. Mr. Sanchez soon quit his job working with incarcerated men to preserve his strength for dialysis treatments…. Critical financial support arrived from Catholic Charities Community Services, which is part of the Catholic Charities Archdiocese of New York, another beneficiary of the Neediest Cases Fund. Mr. Sanchez received help with food, transportation and cleaning as well as rent for his Bronx apartment. (Martin, 2021)
In one dialysis clinic, the dietitian and social worker set up a food pantry. Staff, families, and physicians donated food or funds to supplement dialysis-friendly meals for patients who could not access food pantries. This program continues and has expanded with the addition of local food chains donating food to a designated food closet in the clinic. In another clinic, a social worker and dietitian coordinated a food-pickup service with a local pantry and brought food bags to the clinic to distribute to patients. I worked in a clinic where the dietitian coordinated pantry-food pickup for a patient whose Supplemental Nutrition Assistance Program (SNAP) benefits were delayed due to social service office closures. His lab values began to reflect malnourishment, and I met with him to find out his barriers to accessing food. He had renewed SNAP, but with offices closed, his application was sitting with others in a mail room. The dietitian and I were able to come up with solutions with him. His local church-based pantry, within walking distance of his home, had closed, and he could not get transport to the next nearest pantry in another town. The dietitian and I brought the pantry food to his apartment. He was able to stabilize his labs and improve his health. Afterward, one of the local churches we contacted added a home-delivery food program.
When many areas of dialysis patients’ lives were affected, social workers played an instrumental role in rebuilding communities. Social workers’ ability to use brief and solution-focused interventions and case management skills assisted dialysis patients with their changing needs.
Jennifer L. Rowe, MSW, LCSW, is the owner of Journey Life Balance Inc. and a nationally certified dementia practitioner (CDP). She has more than 26 years of social work field experience and maintains a strong interest in caregivers, multiple sclerosis, end-stage renal disease, and persons diagnosed with Alzheimer’s disease. She can be reached at jennifer@journeylifebalance.com.
REFERENCES
Northern Health. (2020, November 26). “Dialysis at home” patients thriving through lockdown. www.nh.org.au/dialysis-at-home-patients-thriving-through-lockdown
Martin, J. C. (2021, December 16). The pandemic hampered their stride. They’re rising back up. New York Times. www.nytimes.com/2021/ 12/16/neediest-
cases/pandemic-setback-comeback.html
Schiller, B., & Dittrich, M. (2022, May 6). Industry voices—policymakers must prioritize immunocompromised dialysis patients by allowing providers to allocate, distribute therapies. Fierce Healthcare. www.fiercehealthcare.com/providers/industry-voices-policymakers-must-prioritize-immunocompromised-dialysis-patients-allowing