Social workers bring a unique perspective to predialysis care. This article highlights areas where renal social workers are of value to patients who have not started on dialysis (also known as predialysis patients) but are anticipated to need to start dialysis in one month to one year. Physicians can refer patients to a renal social worker as their renal function reaches levels where dialysis is anticipated. The renal social worker can be essential in assisting with predialysis patient care to help with emotional, mental, vocational, financial, and other unmet needs.
When patients start at my dialysis clinic, they are often surprised by how I can assist them. They will verbalize wishing they had known about the information I gave them before their first treatment. Patients do not realize renal social workers have years of education, special training, and skills in areas that affect multiple facets of patient lives. “Given their extensive training in engagement, assessment, intervention, and evaluation skills for individuals, families, groups, organizations, and communities, social workers—who are required in dialysis facilities by federal regulation—are well positioned to help address the area of supportive care for patients, families, and staff” (Anderson et al., 2019, p. 24). Not only are renal social workers highly trained, but their role is mandated by the Centers for Medicare and Medicaid Services: “Each dialysis facility [is] 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” (Avery, 2010).
The social worker who assists patients starting dialysis within one month to one year can be an asset to patients, their families, nephrologists, and hospitals. “There is ample evidence that educating patients prior to the initiation of dialysis is beneficial…. The master’s-trained social worker is uniquely qualified to provide predialysis education to chronic kidney disease (CKD) patients. The social worker can discuss treatment options, job retention strategies, rehabilitation potential, family adjustment issues, and insurance concerns. Social workers are trained to assess mental health issues that facilitate or impede adjustment to chronic illness and dialysis. Social workers combine these skills with a system, rather than symptom, approach that addresses the total functioning of the patient and family” (Browne et al., 2014, p. 19). When a patient hears they must start dialysis, their world pauses. Immediately questions flood their minds: “Will I be able to handle the treatment?How will I balance my care with the needs of my family?How will this affect my job? Who will help me figure all this out?” (UNC School of Medicine, 2022). By providing information tailored to the patient’s specific needs, renal social workers can immediately address such concerns before dialysis starts. Social workers are trained to build rapport, and dialysis offers social workers and patients opportunities to develop meaningful, long-term connections. Renal social workers can “improve patient outcomes and make a significant difference in the lives of individuals who face multiple challenges” (Jackson, 2014, p. 20). Renal social workers can address barriers to insurance, transportation, kidney transplant, anticipated financial strain, modality options, and other case-management needs. Meeting before the start of dialysis can allow patients to plan.
A complication patients experience before the start of dialysis is uremia, a condition in which toxins build up in the blood and alter a patient’s mood and ability to think. “Neuropsychiatric conditions including depression, anxiety disorders, and cognitive impairment are prevalent in patients with CKD. These conditions often make worse the quality of life and lead to longer hospitalizations and higher mortality” (Simões et al., 2019). Renal social workers can validate how the patient is feeling, normalize their mood, identify the need for counseling, and assist the patient with planning for a change to their quality of life. “Early social work referral, psychosocial assessment, intervention, and continued care ensure timely provision of psychosocial support and education. Counseling and advocacy are the cornerstones of the profession” (Jensen et al., 2019, p. 4). Dialysis social workers can be instrumental in predialysis care. Their ability to view from a systems perspective is an excellent asset to patients. These professionals can help reduce both depression and anxiety before dialysis starts.
Jennifer L. Rowe, LCSW, is a social worker with over 25 years of field experience. She has a strong interest in caregivers, multiple sclerosis, end-stage renal disease, and persons diagnosed with Alzheimer’s disease. She is a nationally certified dementia practitioner. She can be reached at jenniferrowelcsw@gmail.com.