Celia Brown, MSW, LICSW, Social worker at Northwest Kidney Centers in Renton, Washington
Karin Ogren, MSW, Social Work Supervisor at Northwest Kidney Centers in Seattle
Each of us has been impacted by staffing shortages in the healthcare system, having to wait longer to get our teeth cleaned or to get a routine colonoscopy. However, dialysis patients have been particularly affected due to their many points of contact within our healthcare system. Each of these contacts causes dialysis patients to be impacted in unique ways, all with real health consequences. Below are examples our social workers have observed since the start of the pandemic
Patients new to dialysis have been delayed in being discharged from the hospital where they started dialysis because there is not a dialysis center with the staffing to accommodate them. They may also be delayed because a nursing home or rehab facility, where they need to be safely discharged to, does not have the staff to safely care for them. Staying in a hospital is difficult and exposes patients to other illnesses. Hospitals also are not well suited to helping them adjust to dialysis and regaining activities that are important to them.
To get out of the hospital, patients may have no choice but to accept placement at an out-patient dialysis center far from their homes. There may not be a nearby center that can accommodate them due to reduced staffing. Some patients in less densely populated areas have had to drive long distances from other counties. One gentleman was able to drive himself but the amount of money he was spending on gas made it hard for him to afford other necessities such as food. He considered stopping dialysis. His social worker helped with community resources, and he eventually transferred to a center closer to home. Other individuals relocating to the Puget Sound Area are finding they are also having to drive long distances to get the treatment they need. It may have been easier for them to find a place to live here than to find a dialysis chair.
At times, prevalent patients who have been hospitalized were not able to receive dialysis because of limited staff who can perform dialysis in the hospital. One patient was hospitalized at her local hospital which usually offers dialysis. However, due to a staffing shortage, she was transported at 3 a.m. to a hospital an hour away which could perform her dialysis. She is elderly and non-English speaking which adds to the impact on her. The family was not able to visit her as easily.
Another key way patients have been impacted by staffing shortages is in our transportation system. This primarily affects patients using Medicaid transportation, but also extends to ADA transportation which has experienced a shortage of drivers. Rides are requested and seemingly assigned but no one comes to pick up a patient. They may miss treatments or be stranded at the center. It is not unusual to have to wait up to five hours for a ride home as it is especially hard to get alternative transportation in the moment for those who need a wheelchair accessible vehicle. Patients who are diabetic have struggled with managing their blood sugar when they unexpectedly missed meals due to long waits for transportation home after dialysis. Those who have no ride to the center are rescheduled but face the same shortage of drivers every time they dialyze.
Patients working towards transplant suffered delays at the start of the pandemic because transplants were put on hold. Now patients are experiencing delays in hearing from transplant centers who have limited nurses and support staff to return calls. They are waiting longer to schedule exams/testing as part of their work-up. All of this means delays in activation and a potentially longer time on dialysis.
The mental health of everyone living through the pandemic has suffered. Patients are coping with this in addition to living with a chronic illness. At a time when mental health services are particularly needed, fewer are available. In a story often echoed, I recently called multiple providers for a patient with insurance coverage for mental health, but was unable to find a single one taking new patients. A colleague reports that at one point she could find only one place in our large metropolitan area that was accepting new patients with Medicaid. All other providers had to shut down intake. Many dialysis patients resist accepting mental health counseling so when they do, it is especially disheartening to tell them there is no one to refer them to.
Patients and the families caring for them are affected daily by the shortage of home caregivers. Patients may be approved through Medicaid for a caregiver who can help them live at home and avoid many hospitalizations, but are being told there is no agency to take on their care. One of my patients is dependent on a wheelchair as she cannot walk. She lives at home with her husband who works full-time. She found a friend who could be her caregiver, but when her caregiver was in a car accident and could not work, there were no agency caregivers who could take on her care temporarily. My patient was dependent on her overly stressed husband who works to keep a roof over their heads and already provides her with significant care. This adds further stress to their relationship.
While not an exhaustive list, this exemplifies many ways in which dialysis patients have been impacted by staff shortages in our larger health care system.