Twenty years ago, the average social worker provided services to 50-100 patients. Today, caseloads average 100-150 and I hear of social workers who provide services to 300 or more patients, often at multiple clinics. The Council of Nephrology Social Workers has a staffing formula that allows calculation of the number of social workers needed by looking at the facility type, patient acuity, and functions that the social work routinely performs. HCFA regulations governing ESRD facilities mandate specific psychosocial services qualified social workers should perform. Paraphrased these tasks include casework and groupwork services, psychosocial assessment, team care planning, and referral to community resources. What do you think is a "workable" caseload for an average acuity dialysis facility? What tasks do you think are inappropriate for social workers to perform considering the ESRD regulations' mandate? What arguments have you found to be effective in communicating to administration the pitfalls associated with high patient caseloads and misassignment of tasks? What arguments have you found to be ineffective?

First of all, it's great to see this topic
among the first to be addressed in such a
far-reaching and direct manner... we need
a clear sense of the current state of dialysis social workers' caseloads if we're ever going to be able to change what needs changing.

I'd like to see the "tasks" issue as one that
can engage all of us in discussion, because I think that has far-reaching implications for change; we all know that there have been wide and somewhat ambiguous parameters applied to the "tasks" that we do as social workers. I must also admit my bias about this issue, because I've always worked in dialysis centers which hired support staff to "social-work-assist" with the daily 300 + patient activities - for example, not only Xeroxing charts for transient treatments, but contacting the transient facilities and arranging the treatments, and also, following up with the patient's responsibilities both prior to, and upon return. Add to that the arranging of routine transportation to/from regularly scheduled treatments (and the associated bureaucracy of local DSS prior approvals) and of course the paperwork associated with transplant center referrals... yes, these are "Tasks," yet they seem to become for some social workers, the sum total of their day's work, and not necessarily meeting the HCFA regulations which mandate the services of an MSW-prepared social worker.
Well, so much for my two cents... I'm hoping we all will be able to express what we're thinking (of course, when we get the time!)

Thanks for your thoughtful reply and great suggestion for extending social workers' capability to provide clinical services through the use of social service assistants or technicians. Does anyone else use similar personnel and have a job description and salary range they'd be willing to share? Has anyone experienced any negatives related to hiring an assistant? What arguments have been effective in getting administration to hire someone to do the non-clinical clerical tasks often delegated to the social worker?