Abstract: FR-PO1061
US Dialysis Social Worker Staffing
Session Information
- Hemodialysis: Clinical Challenges, Patient-Centered Outcomes, and Quality of Life
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Plantinga, Laura, University of California San Francisco, San Francisco, California, United States
- Urbanski, Megan, Emory University, Atlanta, Georgia, United States
- Jaar, Bernard G., Johns Hopkins University, Baltimore, Maryland, United States
- Tuot, Delphine S., University of California San Francisco, San Francisco, California, United States
Background
Because social workers (SWs) play a critical role in managing the significant psychological, social, and logistical challenges faced by patients receiving dialysis, U.S. dialysis facilities are required to have a SW. However, there is no federally mandated maximum caseload, and lower SW staffing and resulting higher SW caseloads could lead to more SW losses, inadequate management of these challenges, and poorer patient outcomes. Our objective was to provide a comprehensive description of U.S. dialysis SW staffing.
Methods
We used facility survey data from the United States Renal Data System (USRDS; 2004-2022) to estimate patient:SW ratios among U.S. dialysis facilities [total number of dialysis patients at facility/SW full-time equivalents (FTEs) at the facility; part-time SWs assigned 0.5 FTE] and the number of open SW positions, all reported as of December 31 of the corresponding year. Facilities reporting no SWs were assigned a patient:SW ratio of 0.
Results
Among 7,474 U.S. facilities reporting >0 SWs in 2022, the median patient:SW ratio was 52. Among 195 additional facilities reporting a patient:SW ratio of 0, 53 (27.2%) reported an open SW position (Figure 1). Median patient:SW ratios declined between 2004 and 2022, as did the percentage of open SW positions, except for a peak of 3.3% in 2021 (Figure 2).
Conclusion
Our unexpected observations of dramatically decreasing SW caseloads over time and of many facilities with 0 SWs but no open positions, along with the likelihood that some SWs (who are not uniquely identified in the USRDS) work across multiple facilities, suggest that current dialysis SW staffing is likely overestimated. More detailed investigations into the actual state of U.S. dialysis SW staffing — using data collected at the SW level — and the effects of this staffing on patient outcomes are urgently needed.