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Supporting Employment for ESKD Patients

When talking with patients about the benefits home dialysis can offer, it’s often brought up that choosing a home modality can offer increased treatment flexibility to continue working. For many patients, this allows them to pursue their passions, engage in their careers and feel more financially secure while receiving employer-provided benefits, including health insurance. Another benefit of working is that engaging in meaningful activity, such as a career, supports physical and emotional well-being. Patients who have stopped working upon starting dialysis may be at risk for depression due to the decrease in their level of activity and social interaction.

Even with job supports, including career counseling and accommodations under the Americans with Disabilities Act (ADA), patients may question their ability to work as they transition to dialysis or if their health condition changes over time. This can be particularly stressful for individuals who receive Social Security Disability Insurance (SSDI) as a result of their kidney disease. After going through the benefits application process—which can be long and complicated—patients may fear loss of the crucial SSDI payments if they return to work.

The Social Security Administration (SSA) provides disability beneficiaries with Work Incentives that are designed to ease the transition back to work for people who receive benefits. Sharing the resources outlined below could help ease patients’ stress.

Trial Work Period

For eligible people who receive SSDI, the Trial Work Period (TWP) is one Work Incentive that can help patients explore their ability to work. With this Work Incentive, SSA provides a nine-month TWP during which a beneficiary will receive their full disability benefits regardless of how much they earn. The nine months do not have to be consecutive and may be within a 60-month rolling period. Patients can be reassured that if they return to work, they will remain eligible to receive their monthly SSDI benefits during this period.

If they fulfill their TWP, patients can continue to benefit from other Work Incentives. One option is the Extended Period of Eligibility, under which patients receive benefits payments if they earn less than a certain amount. And for patients who stop receiving benefits payments due to work and earnings but need to stop working because of their health condition, Expedited Reinstatement offers them the opportunity to start receiving benefits payments again more quickly. Knowing they won’t be required to undergo the initial SSDI application process again could help them feel more confident about considering a return to work.

Additional Employment Support

Encouraging patients to connect with a social worker or benefits counselor can help them learn more about the resources available, including other Work Incentives, and the guidelines to using them. Even for patients who don’t receive Social Security disability benefits, CareerOneStop centers and vocational rehabilitation centers can help individuals find and return to work.

For those concerned about how dialysis will affect their ability to work, social workers can help them better understand their rights under the ADA and connect them with organizations such as the Job Accommodation Network (JAN) to learn more about reasonable accommodations and how to request them. Social workers can also provide supportive counseling, including coping skills for balancing work and dialysis schedules in their personal lives.

By discussing with your patients where they can find the resources they need, you can help encourage them to explore the benefits of working—including an increased sense of fulfillment, community and purpose—and consider how a home modality may offer them the flexibility to pursue their employment goals.

Resources

The Social Security Red Book

Social Security’s Ticket to Work program

CareerOneStop

ADA National Network

Job Accommodation Network

Elizabeth Jones MSW, LCSW, FNKF

Elizabeth Jones MSW, LCSW, FNKF

Elizabeth Jones MSW, LCSW, FNKF has been a nephrology social worker since 1991 working in hospital, transplant, and outpatient dialysis settings. She is the DaVita lead social worker for the Atlantic Stars division which encompasses the Washington D.C. metro area. Elizabeth is an advisory board member for the Dialysis Patient Citizen’s education center and she is the program co-chair of the NKF CNSW Spring Clinical Meetings. Elizabeth currently serves on the Quality Insights Network 5 board of directors. She feels passionate about patient education and empowerment.