Defending dialysis social workers

[HDSW]

After reading all the negative comments made about dialysis center social workers, I feel compelled to write in defense of my profession. I am disturbed by how we are viewed as good-for-nothings, useless, and annoying.  There appears to be a misunderstanding and at times unrealistic expectations of what renal social workers can help with. I want to clarify our role and responsibilities.       

-   I didn’t go to school specifically to be a renal social worker. I learned about human behavior, developmental stages and therapeutic methods and theories. The degree is similar to a Business degree. Just because you have a business degree doesn’t mean that you know how to do marketing or accounting. You had to learn it on the job. Everything about the disease, treatment methods, etc. are learned on the job. I personally think it is out of my scoop of practice to be educating/explaining treatment methods since I feel it is the MD’s responsibility. But that’s another argument for another day.
-   I am not there to psychoanalyze you. It’s not the setting and I don’t have the time. There is no privacy for you to divulge deep, personal information. I am not there to heal your childhood wounds. What I can help with is providing you with emotional support. Losing your kidney function is a loss. I help you process that loss: loss of things you use to be able to do, loss of bodily function, loss of work, etc. My role is to help you maintain or gain control of you body/life. I try to help you adjust to a new “normal”. It’s about helping you cope and manage your life on dialysis. My role is to empower you to live your life as fully as possible ON dialysis.
-   About insurance/Medicare/Medicaid/assistance programs, etc. I did not take a class in grad school titled “federal/state benefits for the elderly, disabled and poor”. No such class exists. I learned the stuff on the job. Also, here is a secret: I am not privileged to information that you are not able to find yourself on their websites. I don’t work for Medicare, Social Security or any of the non-profit agencies; I don’t know the specifics of their program. It is your responsibility to call them and get clarification. Thanks for the vote of confidence but I do not know everything and it is impossible for me to know everything.
-   Please know that I am required to talk to you per Medicare mandate every few weeks. It takes two to make a conversation happen. Don’t make it so difficult, throw me a bone. If you want help from your social worker, then talk to me and ask questions. I am not a mind reader. If you tell me, I may be able to research the information, give recommendations or if not, then I can sit there and listen to you vent. Do not expect me to know what you want. Do not get mad at me for bothering you. If you do not want to talk to me, just kindly say “I’m good. Thanks for your visit but I don’t need any social services right now” and I will leave you alone until next time.
-   Please know that there is only 1 of me, and at times 100+ of you guys. Where I am right now, I am the ONLY social worker for 106 patients. Additionally, I’m PART TIME working 3 days a week!!

My role as a social worker is to empower you and guide you. I am not there to do things FOR you. I am not your personal assistant. I can guide you to complete financial assistance paperwork, but I’m not filling it out for you. I can advice you on what to ask Medicare to ensure you are getting proper insurance coverage but I’m not calling Medicare for you. We really did enter the profession to help people and we really do care. The key word is HELP, not enable. I do not wish to be on dialysis and can only imagine how tough it must be to be dependent on a machine for your livelihood. However, just because you are chronically ill does not give you the right to demand special treatment, to belittle, demean or be rude to anyone. 

[okarol]

Interesting. I'm sure you'll get some responses.
Please take a minute a go to our "Introduce Yourself" section - that's where the first post goes.
Thanks,
okarol/admin

[greg10]

After reading all the negative comments made about dialysis center social workers, I feel compelled to write in defense of my profession. I am disturbed by how we are viewed as good-for-nothings, useless, and annoying.  There appears to be a misunderstanding and at times unrealistic expectations of what renal social workers can help with. I want to clarify our role and responsibilities. 
.... but I’m not calling Medicare for you. We really did enter the profession to help people and we really do care. The key word is HELP, not enable. I do not wish to be on dialysis and can only imagine how tough it must be to be dependent on a machine for your livelihood. However, just because you are chronically ill does not give you the right to demand special treatment, to belittle, demean or be rude to anyone.

Welcome to the forum.  I am sure you have a thankless job.  You spent most of the introduction writing about what a social worker is not supposed to do and very little at the end about what your job description is.  You made your final point about helping and enabling but that is really a distinction without a difference.  You don't seem to realize that to many patients, you are the only advocate for patient's rights in a sea of corporate and government red tape.  You could be the only out there making a difference between help and no help, between a life and no life for the patient.  Yet you seem to take this job as an insult rather than a chance to make a difference in the lives of these unfortunate people.

Perhaps you are right.  You really can't do a lot for your patients - yes, they are your patients and you are supposed to care for them - and this shows too often by the fact that most social workers don't really know their patients.

[monrein]

After reading all the negative comments made about dialysis center social workers, I feel compelled to write in defense of my profession. I am disturbed by how we are viewed as good-for-nothings, useless, and annoying.  There appears to be a misunderstanding and at times unrealistic expectations of what renal social workers can help with. I want to clarify our role and responsibilities.       

-   I didn’t go to school specifically to be a renal social worker. I learned about human behavior, developmental stages and therapeutic methods and theories. The degree is similar to a Business degree. Just because you have a business degree doesn’t mean that you know how to do marketing or accounting. You had to learn it on the job. Everything about the disease, treatment methods, etc. are learned on the job. I personally think it is out of my scoop of practice to be educating/explaining treatment methods since I feel it is the MD’s responsibility. But that’s another argument for another day.
-   I am not there to psychoanalyze you. It’s not the setting and I don’t have the time. There is no privacy for you to divulge deep, personal information. I am not there to heal your childhood wounds. What I can help with is providing you with emotional support. Losing your kidney function is a loss. I help you process that loss: loss of things you use to be able to do, loss of bodily function, loss of work, etc. My role is to help you maintain or gain control of you body/life. I try to help you adjust to a new “normal”. It’s about helping you cope and manage your life on dialysis. My role is to empower you to live your life as fully as possible ON dialysis.
-   About insurance/Medicare/Medicaid/assistance programs, etc. I did not take a class in grad school titled “federal/state benefits for the elderly, disabled and poor”. No such class exists. I learned the stuff on the job. Also, here is a secret: I am not privileged to information that you are not able to find yourself on their websites. I don’t work for Medicare, Social Security or any of the non-profit agencies; I don’t know the specifics of their program. It is your responsibility to call them and get clarification. Thanks for the vote of confidence but I do not know everything and it is impossible for me to know everything.
-   Please know that I am required to talk to you per Medicare mandate every few weeks. It takes two to make a conversation happen. Don’t make it so difficult, throw me a bone. If you want help from your social worker, then talk to me and ask questions. I am not a mind reader. If you tell me, I may be able to research the information, give recommendations or if not, then I can sit there and listen to you vent. Do not expect me to know what you want. Do not get mad at me for bothering you. If you do not want to talk to me, just kindly say “I’m good. Thanks for your visit but I don’t need any social services right now” and I will leave you alone until next time.
-   Please know that there is only 1 of me, and at times 100+ of you guys. Where I am right now, I am the ONLY social worker for 106 patients. Additionally, I’m PART TIME working 3 days a week!!

My role as a social worker is to empower you and guide you. I am not there to do things FOR you. I am not your personal assistant. I can guide you to complete financial assistance paperwork, but I’m not filling it out for you. I can advice you on what to ask Medicare to ensure you are getting proper insurance coverage but I’m not calling Medicare for you. We really did enter the profession to help people and we really do care. The key word is HELP, not enable. I do not wish to be on dialysis and can only imagine how tough it must be to be dependent on a machine for your livelihood. However, just because you are chronically ill does not give you the right to demand special treatment, to belittle, demean or be rude to anyone. 

Wow, you appear to be as overwhelmed as your clients might be except that while they too don't wish to be on dialysis, they lost that particular lottery.   One of the things that is key about being on D is that even the most competent, independent and clear headed people become somewhat impaired, especially at the beginning and they feel weak, sick, grief-struck, lost and buried under the rubble of a life that seems to have collapsed on itself.
While I agree with many of the points you make, I think you might be missing the main point about your role and your job.

a)  Although your training is of a more general nature, it is your responsibility to very quickly get up to speed on the particulars of ESRD since that is what your clients are struggling with specifically and it is what has derailed their "normal" processes of development.  And yes, there will be people who in addition to this serious crinkle also have the usual litany of mental illnesses, childhood traumas, interrupted development etc.   Some don't cope well to begin with and now they have this.  You can expect a certain percentage of 'difficult' clients, as you would find in any setting, except that they're now having to deal with an extra helping of difficult situations.  Theories must now be translated into practice, and many times clients won't seem to fit the theories.

b)  You are correct that psychoanalysis is not what you do, but how can you provide emotional support, help process profound loss on almost every level (depending of course on the individual...no cookie cutters here or anywhere actually) and help people to cope if you are unable to listen to and really hear deep personal information.  Now, I understand that the limitations of your job may make this an impossible task but to say that you can provide support and coping mechanisms without understanding the human at the heart of things is nonsensical and will ALWAYS leave you and your client as frustrated as hell.  Simply venting is also frustrating if one has the feeling that the listener must go quickly or cannot really understand the depth of the pain.  You may not be able to do anything to change things but the feeling of being understood, profoundly understood, is hugely supportive and that is what your job ought to be aiming for.

c)  You need to investigate and have ready all the relevant information from Medicare, SS, or whatever.  You ought to make this a priority and create your own independent learning project or class to assemble this information.  Sick people, even normally very bright ones, are  often notoriously unqualified to process complex information (you will undoubtedly learn this lesson personally at some time in your life, but for now you can take this from me) and if you are to guide them through the maze you will need to know and become very familiar with every twist turn and dead-end.  What you don't know, you must find out and remember it for the next client with the same issue.  All areas of social work have specific frames of reference and your job is to know know yours inside out.

d)  People will never talk to someone they feel has no time for them as an individual.  If your approach feels "mandated" you will never have real conversations.  Theyt will be perfunctory and useless for the most part.  It is not your clients problem how stretched you are.  They have enough on their plates without feeling the demands of your job.  That needs to be taken up with your boss.

e)  People on D are not dependent on it for their livelihoods.  It has often robbed them of their livelihoods since they sometimes can no longer work, either temporarily or permanently.  They are dependent on it for their very lives.  Your job is your livelihood and you can quit or change it.  No such possibility for your clients.  This very important fact is at the root of much of what you will encounter in your extremely difficult job but you can be of real help if you are willing to go there.

f)  You are quite right that no one should be rude, demeaning etc. but in social work we must be prepared to hold steady with people as the navigate some very stormy emotional and physical storms and illness can cause people to be their worst selves at times.  Some are just plain jerks, in the same way that some social workers are just plain useless, that will never change but I'm always hopeful that clients can find their better selves and that social workers can learn to be better at providing both instrumental help, emotional support and indeed information of all kinds.

I completely understand how hard your job is since I have done it...not in the US, I live in Canada and our systems are indeed different.  I also worked more in the area of adolescent and family therapy although I did a student placement on the renal ward of a large urban hospital.

I'm also very familiar with the travails of the renal patient since I've been coping with this illness for many years and am currently on my second transplant with a total of 6 years hard time on dialysis.

   to IHD, thank you for sharing your perspective and for reading mine.   

[HouseOfDialysis]

We have two social workers at my clinic that are fulltime for all of our patients. I can't even estimate how many are in the home/clinic programs comibined, but I will say that EVERY time I step in the clinic be it for an Epo shot or lab draw, they step in and nicely ask if they can do anything for me. I know some organizations like AKF or NKF like to work through social workers, I assume for a paper trail, but most of the paperwork they submitted on my behalf, I could have done on my own. I volunteered to be in control of all my paperwork, but they handle it and I get copies of everything they send, so I am not out of the loop. How long this arrangement will be problem free, I don't know. It's only been active since February.

But I have nothing but positive experiences with my social workers so far.

[Deanne]

You have a very heavy caseload and I hear your frustration. While your time is very limited, maybe you'd be viewed in a more positive way if you phrased your limitations more positively. I don't know - I'm not yet on dialysis. It's just that as I started reading your post, everything was stated in a negative way. I understand this is a vent and it doesn't mean you phrase things negatively when you're talking to a patient.

For instance, to turn your message into a more positive one:

-   In school, I learned about human behavior, developmental stages and therapeutic methods and theories. The degree is similar to a Business degree. Everything I know about kidney disease, treatment methods, etc., I'm learning on the job. As patients, you're also my teachers. 
-   I want to listen to you and provide emotional support for you. I want to help you process the loss of your kidney function and help you adapt to your life on dialysis. I can help you learn coping skills to empower you to live your life as fully as possible. It is unfortunate the setting I have in which to talk to you doesn't allow the privacy needed for you to divulge deep, personal information.
-   While I admit I don't know everything there is to know about insurance/Medicare/Medicaid/assistance programs, etc. I can help you identify resources so you can call to understand the specifics of your specific program or situation. 
-   I need to report to Medicare regularly about the frequency of our conversations. If you do not want to talk to me, It's ok for you to tell me so. I'll need to ask you again in a couple of weeks if you want to talk, just to make sure the Medicare people know our lines of communication are open.
-  If you need my help, please know that I'm willing to talk to you, whether you need to vent, or if you want to ask for my help in researching information or giving you recommendations or suggestions. It would help me if you could be specific about the help that you need.
-   I'm sorry if I don't always spend as much time with you as you'd like. I wish I could spend more time with you, but there are 106 of you and only one of me.

[jeannea]

We have 2 social workers for about 230 patients. They each work 4 days a week.  I think they are wonderful and always try their best to be helpful and sympathetic. Recently I had an issue they tried to help with but didn't succeed. But I know they tried. I think that someone else was right that in every job you will have easy people to work with and difficult people to work with. One of the reasons we come here to vent is because our social workers don't have time to be personal counselors. You shouldn't take that personally. Are you sure you're in the right job? Not trying to be mean but if you get that upset about us it may be time to re-evaluate.

[noahvale]

**

[Rerun]

I think this is just a symptom of the failure of the Dialysis Clinics which are for profit.  Medicare requires a person to go around and visit the patients.  They are not going to pay a lot so we get a person but not really one that knows anything about dialysis.  On the job training.  Great! 

My Social Worker sits and yawns while I talk to him.  Really?

Most dialysis patients are elderly and very sick.  They need someone who will dig in and help them.

[carol1987]

 

-    
-   
-   About insurance/Medicare/Medicaid/assistance programs, etc. I did not take a class in grad school titled “federal/state benefits for the elderly, disabled and poor”. No such class exists. I learned the stuff on the job. Also, here is a secret: I am not privileged to information that you are not able to find yourself on their websites. I don’t work for Medicare, Social Security or any of the non-profit agencies; I don’t know the specifics of their program. It is your responsibility to call them and get clarification. Thanks for the vote of confidence but I do not know everything and it is impossible for me to know everything.
-   Please know that I am required to talk to you per Medicare mandate every few weeks. It takes two to make a conversation happen. Don’t make it so difficult, throw me a bone. If you want help from your social worker, then talk to me and ask questions. I am not a mind reader. If you tell me, I may be able to research the information, give recommendations or if not, then I can sit there and listen to you vent. Do not expect me to know what you want. Do not get mad at me for bothering you. If you do not want to talk to me, just kindly say “I’m good. Thanks for your visit but I don’t need any social services right now” and I will leave you alone until next time.
-   Please know that there is only 1 of me, and at times 100+ of you guys. Where I am right now, I am the ONLY social worker for 106 patients. Additionally, I’m PART TIME working 3 days a week!!

My role as a social worker is to empower you and guide you. I am not there to do things FOR you. I am not your personal assistant. I can guide you to complete financial assistance paperwork, but I’m not filling it out for you. I can advice you on what to ask Medicare to ensure you are getting proper insurance coverage but I’m not calling Medicare for you. We really did enter the profession to help people and we really do care. The key word is HELP, not enable. I do not wish to be on dialysis and can only imagine how tough it must be to be dependent on a machine for your livelihood. However, just because you are chronically ill does not give you the right to demand special treatment, to belittle, demean or be rude to anyone.

I don't think you did a very good job defending your profession....

If what you posted about medicare is true than I would say that your position is a waste of $$$  I could just take a minute on the way into the dialysis clinic every few weeks... look at the medicare site on a computer and check off a box , and there would be no need for you to walk around the room and stop at my chair for 2 seconds!!....


Let me get my violin out and play for you.... feeling overwhelmed because you work part time and have 100 patients....  "cause until you are doing that and suffering from ESRD and going to dialysis and trying to raise a family ..... I don't want to hear your complaints about patients ... especially here  on IHD where we come to actively search for helpful information...

oh and we don't depend on a dialysis machine for our "livelihood"  you do because you work at a dialysis clinic ...we depend on it for our lives..

and I don't believe you are qualified to psychoanalyze anyone anymore than you can give them information about their medical treatments..

[lola]

  oh and   

[CHeatherS]

Hmmmm, I have two "issues" that come to mind.  One is that there are SO MANY folks who have jobs that they don't like....  mostly government jobs.  Oh how I wish folks would listen to their hearts and go into the kind of work that they are cut out for, and enjoy.  It makes life for all around so much better.

I have been thinking, as I have been going through ESRD, that there must be so many who "fall through the cracks" and don't have someone to care for them, help them, and draw out their desire for life.  I have actually been wondering how I could be of help, once I get some manner of health back myself.  Sometimes we don't seem to have compassion for others when we haven't found ourselves in need, or suffering.  It's only after our own struggles that we learn to care for others.  Meanwhile, we have bloated bureaucracies that fill up their worker bee slots with folks who feel entitled to a job and respect for that job. 

Well, I think that Monrein spoke very well regarding your initial post here.  I too  you......  and hope that this dialog can encourage as it goes along..... 

Blessings
Heather

[Big E]

I think that at an absolute minimum, a renal social worker should know everything there is to know about Medicare/Medical.  If your patients can look it up on the internet, why can't you?  To say you don't know everything because you don't work for Social Security is absurd.   Sorry to be negative, but if it's so easy to look up everything ourselves on the net, we wouldn't need social workers, would we?

BTW, welcome.  At least you've got guts.

[Meinuk]

HDSW, I am not going to be as gentle, constructive or circumspect as Monrein was (she is a much better person that I). I found your post to be emblematic of part of what is wrong with the provision of dialysis today.  Worker resentment and apathy. (and I use the word "Worker" as a generic for the industry.  Not just SW.) Your post made my semi toxic* blood boil.

   If you did not take an American Healthcare Systems class (AT LEAST) when you were going to school to be a social worker, either you went to school many years ago, or you somehow missed that class.

An overview of Government Benefits is part of a basic curriculum, even if it is not detailed for dialysis, you have been given the tools and knowledge to speak the language and understand the basics of the system.  You should NEVER stop learning once you graduate especially in such a dynamic and challenging environment. Stop making excuses. BTW, writing to the computer literate few and telling them that they could know as much as you do about medicare (web search, really?!?) is offensive and so off the mark that it is insulting to everyone.  You and I both know that the majority of the >350,000  patients on dialysis in the United States are not on the net.  How dare you condescend to the empowered ones who DO have access and know how to use it.  I hope your elderly relatives aren't told to "look it up on the web" when they have a question about their Medicare.

Blaming your patients because your clinic is understaffed is unprofessional and simply WRONG.  Take it up with your management, NOT your clients.  You are still expected to give 100%.  If you can't, either try to fix it or move on and stop letting the animosity build. When you write what you did on a patient peer-to-peer support board, you DID blame you patients. You never know who is on these boards or who is reading them.  You could be any of our burnt out social workers or you could be the voice of all of them, when you take up the mantle of defending your profession. 

There are MANY tools out there to help you learn your job.  If that sounds condescending, it is.  From the condescending tone of your post, you are used to it.  We are people.  We have the right to criticize those who we feel need to be criticized. Rather than defend a bad position, you should have gone to the posts that offended you and offered a SW POV, rather than attempt to put us in our place/"educate" us RE: unrealistic expectations.  In many cases, those rants that you were offended by were caused by realistic expectations, and substandard social work.  I have encountered many, many under-trained/overwhelmed/burnt out social workers and a few GREAT ONES. A great one wouldn't need to defend their position, and would know how to approach a situation without antagonizing a population.

You are a paid professional who is posting to defend your profession, yet you simply state that "I am not privileged to information that you are not able to find yourself on their websites." SHAME ON YOU.  You have education, opportunity and HEALTH on your side (I am not even mentioning the fact that you are PAID to be a resource) If you feel that your time is mismanaged, take it up with your employer NOT YOUR PATIENTS.

You need to re think why you are so defensive and go and start networking, educating yourself, speaking to your employer and working at correcting the toxic environment that exists in dialysis clinics today.

My suggestions:

Really listen to what Monrein and Noah Vale wrote to you they are being gentle and constructive.

Look at the Decreasing Patient/Provider Conflict Module in the Five Diamond Program for Patient Safety:  http://www.esrdnet5.org/5Diamond.asp#modules

Reassess you motives. If you posted your defense because you are trying to place blame on your burn out or are looking for an excuse to hate your job even more, then yes, brand your patients as the enemy and MOVE ON.

Go to Life Options Renal Rehabilitation and start reading  http://www.lifeoptions.org/

Read up on Medicare and make it a priority, as well as your state SHIP and private insurance options.

If you simply wanted to vent, and came to IHD to be a productive part of the forum, stop being defensive (in the guise of "educating" us) and start being pro active.

You may never forgive me for speaking so negatively to you, and it may be just the "fight" you were looking for; if you simply wanted to condescend to patients and smack them on the nose about your "Scope of Practice", well, understand that some of those patients can smack right back, and know your scope of work pretty well.  Actually, I am pretty well versed in the whole CfC and the Interpretive Guide, and I am in no way, shape or form a SW, just an educated professional with CKD.

My position is, that it is professionals with an attitude like yours that are killing us.  I want you to stop being defensive (you can chuckle at the irony as I am being so aggressive) and think about these PEOPLE that you are so angry with/offended by.  We didn't hire you.  We didn't have that choice.  You didn't pick your patient population, but you did choose your job.  The only person with a choice in this scenario is YOU.  I hope that you make a wise one for all involved. Stop defending the flawed system and try to start making it work.

You know, I have a history of being a person who tries to work with dialysis facility staff.  I even have a speech about it (powerpoint with pictures) I usually tell a crowd of dialyzors that "We need dialysis units, we need to work with them.  As a person who suffered after her unit was closed by the state, I see the downside".  I just have to think HDSW, if you ticked ME off, what message are you sending? How do we rehabilitate condescension and apathy in our providers?

*(no worries, the kidney is fine, Tacrolimus is nephrotoxic)

(edited because I am still angry about this)

[kamar55]

"Please know that I am required to talk to you per Medicare mandate every few weeks. It takes two to make a conversation happen."

Really? I'm lucky if I see my social worker twice a year.

[WishIKnew]

Wow!  You really need to get out of this job which you obviously hate and find something for which you are better suited.  You obviously are not helping your patients or yourself right now....  Please, take you healthy self and you college degree and go find your livlihood somewhere else!

[cattlekid]

Here's a few things that I've noticed in my first three months of in-center D:

1.  Because I started on an emergency basis, I didn't see my SW for the first two weeks I was in-center.  I felt adrift and alone.

2.  I really wish the SW was available outside of during treatments.  She only comes around when it's required and it's always at the later part of my treatment when I am washed out and don't feel like talking.  So I'll give her the basics of my current insurance situation and that seems to be enough for her.  I might have other things I'd like to talk to her about but a) I don't want to air my circumstances in the middle of the floor and b) I'm usually drained and not thinking clearly. 

3.  I did have to fill out a questionnaire last week about how my life was going while on D.  Some of the questions were quite personal and I really don't want to discuss the reasons behind my answers in the middle of the floor (see point above).  I also don't really know what the SW is going to do with this information - is there really anything that she is going to do because I'm peeved that I have to give up half a weekend day at the center and it interferes with my life with family and friends?

4.  I also think that the SW needs to be fluent in the languages prevalent in use by the patients.  Many of the patients in my center speak only Spanish and there is often no translator available when the SW is making her rounds.  I don't think these individuals are getting quality service or the information that they need.

[Jie]

I did not need any help from my social worker during my dialysis. She called to talk with me every month. It was a nice chat with her once month.

[YLGuy]

"Please know that I am required to talk to you per Medicare mandate every few weeks. It takes two to make a conversation happen."

Really? I'm lucky if I see my social worker twice a year.

I know! I have been in my center for about 2 years.  The social worker was refinancing her home when I first got there and I helped her with her paperwork.  She has never been to see me again.  One time I wanted to travel and asked her about centers in the area I was going to and all she did was hand me an 800 number. 

[jamoman]

 HDSW your explanition explains exactly why most patients feel the way they do. find it our selves on the net indeed!

[jbeany]

Okay, let me add my own defense of social workers, but HDSW, you aren't going to like it much.  I had an excellent social worker when I was in-center.  She was constantly involved with the patients, remembered us by name, and took an active interest in all of us.  She worked full time, yes, but she covered 4 centers worth of patients, so I doubt her case load was any less than yours.  I don't know what she would have used to "clarify her role and responsibilities," but she managed to do an awful lot of what you claim you aren't responsible for.  (And for the record, she managed all of while raising a daughter and navigating life in a wheelchair, so she had plenty of practice at relating to those of us stuck in the "chair.")

  I personally think it is out of my scoop of practice to be educating/explaining treatment methods since I feel it is the MD’s responsibility. But that’s another argument for another day.

Maybe so.  But then again, my social worker was quick to ask if I had considered PD, did I understand the difference, and was I clear on why my doc thought hemo was the best choice for me.  I had a good doc, too, so I had the information already, but she certainly thought it was within the scope of her job to make sure I understood my options.  When I brought up the NxStage, and shared the information on it I had found on here from Epoman's experiences, she not only looked into it, she shared the information with the rest of the staff. 

-   I am not there to psychoanalyze you. It’s not the setting and I don’t have the time. There is no privacy for you to divulge deep, personal information. I am not there to heal your childhood wounds. What I can help with is providing you with emotional support.

No, the clinic floor is never going to be an ideal place for a private conversation.  But there's a solution.  It's called a phone consult.  And I quote my social worker, "If you ever want to talk about anything that you would feel better discussing in private, we could meet after your treatment or you could just call me."  I don't buy that you can provide emotional support without getting at least some sense of a person's background.  Kidney failure is not some isolated incident that is unrelated to a person's personal history.   Their coping skills are a product of their childhood.  Are you expected to treat mental illness?  No.  But sometimes, you really just need to listen, even if the rambling is about what happened when they were 12.  For heaven's sake, I do that much just volunteering to help people fill out legal forms at the local family law court.

I don’t work for Medicare, Social Security or any of the non-profit agencies; I don’t know the specifics of their program. It is your responsibility to call them and get clarification. Thanks for the vote of confidence but I do not know everything and it is impossible for me to know everything.

So, in spite of having 100 plus patients who need the information, you don't feel any need to familiarize yourself with the complex programs that they are REQUIRED to sign up for?  Heck, why bother to learn the basics when you can just tell them to go to the website?  Have fun, and oh, yeah, there's a computer at the library if you are old, sick and alone and have never touched a computer in your life.
  When I lost regular insurance coverage, my social worker understood the programs and helped me navigate the forms.  Plus she knew info about where and how to sign up for food stamps, medicaid, etc.  And passed along info on scholarships and SS disability and and and.....  How can you help them adapt to the "new normal" if you haven't learned any of the information they need to know to get there?

If you want help from your social worker, then talk to me and ask questions. I am not a mind reader. If you tell me, I may be able to research the information, give recommendations or if not, then I can sit there and listen to you vent.

If they've already asked you for info on Medicare, etc, and you have chased them off to let them figure it out on their own, how many more times do you think they will make the effort?  And yes, I know that people can be rude - but the next time you are half dead and sick and queasy with the flu, see how excited you get when someone wants to chat. 

My role as a social worker is to empower you and guide you. I am not there to do things FOR you. I am not your personal assistant. I can guide you to complete financial assistance paperwork, but I’m not filling it out for you. I can advice you on what to ask Medicare to ensure you are getting proper insurance coverage but I’m not calling Medicare for you.

And with a competent patient, I agree, you shouldn't have to fill out paperwork or make the phone calls.  But guess what - they aren't all competent, and sometimes you are the only one they may have to help them.  I've seen my social worker go through forms line by line with patients.  I admit, I didn't quite understand why they would need it at the time, but after volunteering to help at the courthouse, I get it now.  Not only are the forms confusing, but with the number of illiterate or nearly illiterate people in the US, it's a necessity to go above and beyond for some.  Some of those Medicare forms and programs confused me, and I've got a college degree in technical writing.  It's government red tape, for heaven's sakes.  Telling a patient to go look it up for themselves should not be an answer from a social worker - ever.

You contradict yourself a lot in this post.  You don't want to have to explain the government programs, but you are upset when they don't want to talk to you, so you can't answer questions or research answers for them.  You don't want to discuss their childhood problems, but you are happy to listen to them vent.  Which is it?  It sounds to me like you are doing your Medicare mandated visits and don't have any interest in doing more than the bare minimum to meet those needs.  I never saw my social worker greeted rudely on my any of shifts - but then she was always a happy, helpful person who loved her job.  You get back the vibes you put out, after all.  So maybe the first place you should look for explanations for the rudeness is in your approach.  Seriously, you get annoyed when sick people don't want to talk to you while they are having an intense medical treatment?  Cripes, how many of them did you shake awake to get them to answer you, so you could check off your mandated consultation?

[GraphicBass]

I have no use for the social worker, although she seems like a nice enough person. I or my wife handle all financial, social and travel arrangements without involving her if possible, and if not, we don't let her make ANY decisions on our behalf. I don't like her questions, as they feel like interference in my life to me. We deal directly with the corporate offices and inform the center of what we're doing.

They actually seem to appreciate not having the extra work.

Of course, this is my specific example, and I'm still able, health-wise, to manage my care, and I have an excellent support from my wife and daughter.  I realize not every patient has those resources. I have seen the social worker help the clinic manager extensively, as well as other patients who are not able to fend as well for themselves.

Sorry to be harsh, but with your attitude, I wouldn't let  you within ten feet of my chair.

Just sayin'.

gary

[Meinuk]

And furthermore...

I hope your charts are up to snuff when the state comes to visit.

I noticed that you never mentioned Vocational Rehab in any of your post, BUT you made the Freudian slip "depending on the dialysis machine for livelihood".  Resentment much?  Comeon, you are bragging about finishing graduate school, how can you confuse staying alive with livelihood? You didn't, and I am calling you out on it.  Consciously or sub-consciously, your resentment reeks from those words.

If you feel stressed about your work, and feel threatened by IHD, why don't you have your more net savvy patients come to us and then act as peer counselors?  Be a resource for them to help themselves. That will free up your time to actually learn about CKD-5, Medicare, Medicaid and Private Insurance (oh, and vocational rehabilitation) and what is needed to properly treat your patient population.

And giving a patient who asks about other modalities an overview of each should be in your comfort zone.  It is NOT a medical decision that you are making.  Just handing them a piece of paper on ALL treatment modalities and referring them to their nephrologist would be appropriate and encouraged. You need to consider how you say things more carefully if you are going to stay in this business.  Giving a patient information is NOT a promise. It is empowerment, and it is totally within your scope of work.  But then again, if you are in a for profit center that does not offer those treatments, who are you protecting?  The patient's optimal health or the Shareholders stock dividends?

Here is a very brief and incomplete snapshot what the state will be looking for from you: (I deleted the V tags, you can look for yourself on the assessors MAT - it is a quick and easy Google search) I bolded the parts that I hope you are covering with your mandated visits.  Better yet, look your unit up on pro publica and see how you are doing compared to your peers (that is an easy internet search too).  Hopefully that is what your informed patients are doing.

494.80 Patient assessment: The interdisciplinary team (IDT), patient/designee, RN, MSW, RD, physician must provide each patient with an individualized & comprehensive assessment of needs

- Health status/comorbidities
- Dialysis prescription
- BP & fluid management
- Lab profile
- Immunization & meds history
- Anemia (Hgb, Hct, iron stores, ESA need)
- Renal bone disease
- Nutritional status
- Psychosocial needs
- Dialysis access type & maintenance
- Abilities, interests, preferences, goals, desired participation in care, preferred modality & setting, expectations for outcomes
- Suitability for transplant referral
- Family & other support systems
- Current physical activity level & referral to vocational & physical rehabilitation

Oh, and after you assess and then re-assess, YOU ARE SUPPOSED TO WORK WITH THE PATIENT ON A CARE PLAN.  But from what you have written, it is simply all about the Medicare mandated "visit". Dialysis is CHRONIC. Assessment and re-assessment is part of your JOB. And a care plan has to be in place until the patient no longer needs care.  BTW what are you doing about palliative care? (you know, that is a treatment option too)

And in case you missed it, ALL CAPS is yelling.  Imagine that I am also shaking my finger at you.

I could easily rant on all night, I suspect that I will have the phrase "unrealistic expectations" running through my head for days.

As a patient, I have very realistic expectations.  That all of my trained and certified professionals know their job, and bring expertise to my care team that I cannot furnish myself.  If you are saying that we can just search for information about Medicare and insurance by Googleling it, well, then our healthcare system has reached an all time low.

And if you are still trying to weasel out of understanding Medicare and or Insurance at an expert level because it wasn't "taught" to you, not being able to pay for dialysis is a barrier to care, and grounds for an IVD. If you don't feel that that is in the "Scope of Practice" for a social worker, than I need to ask, what do you think that a social worker does?  Do you think that it is an easy job?  Do you understand why we need good social workers?  Do you understand why we need an industry that can take care of a patient as a whole?

HDSW, it takes a thick skin and an amazing capacity to be a good dialysis social worker - the first thing that has to go as far as I am concerned is the condescending attitude - if you play nice in our sandbox, we play nice right back.

Grow a thicker skin, understand that sometimes, the answer is NO, and when it is NO, be prepared to back it up.  And the best answer (other than "look it up on Google")?  "I don't know, but let me get back to you either with the answer or who may have the answer."

Yes, a conversation is a two way street, but so is respect.

[Rerun]

I'm sorry, but if you speak Spanish learn ENGLISH!  I'm not paying tax dollars to pay a SW who can say "look it up on the net" in Spanish!

       

[jbeany]

I don't know, Rerun.  I help lots of people at the courthouse who can carry on a perfectly coherent conversation in English, but still need a translator when it comes to legal forms.  Legalese isn't any easier to translate in a second language than government forms.  Learning to work and carry on a conversation in a second language isn't always enough to translate some of the mumbo-jumbo on paperwork.