Vocational Rehabilitation

The Rehabilitation Program of the ESRD Network of Texas is designed to work with both professionals and patients to ensure that incipient dialysis patients are informed of the benefits of continuing to work. Continuing education for social workers on Rehabilitation was presented during the Annual Meeting. Additional instruction was given to facilities to encourage staff to speak with their patients about continuing to work or volunteering options. Further, the program is aimed at ensuring that rehabilitative opportunities are presented and available to all suitable ESRD patients. Criteria and Standards to identify suitable vocational rehabilitation candidates that were developed and adopted by the MRB support the efforts of the Life Options Rehabilitation Advisory Council (LORAC) and the Department of Aging & Rehabilitative Services Commission (DARS). The Criteria and Standards continue to be distributed automatically to all new facilities and upon request to existing clinics.

Vocational Rehabilitation (VR) data is collected from each facility in the Annual Facility Survey utilizing standardized CMS data elements and definitions. For 2006, the Network collected self-reported VR data on facility patients 18-54 (n= 11,091) as of the last day of the year.

The Network and the MRB annually review the Vocational Rehabilitation (VR) Activity Report. In the 2006 report, Texas facilities reported that 18.3 percent of patients between the years of 18 and 54 years of age were employed as of year-end, while 3.3 percent were attending school full or part time. The percent of patients receiving services from VR or other VR Related Service Providers (Public or Private) has steadily decreased from 4.2 percent in 2002 to 2.1 percent in 2006.

The ESRD Network of Texas continues to work with the Department of Aging & Rehabilitative Services Commission (DARS) in an effort to address the ongoing barriers for referral and the availability of services. Currently, rehabilitation counselors are evaluated based upon the number of cases successfully placed in employment. Dialysis patients, because of their thrice weekly, four-hour treatments, are more difficult to place and require more time and effort on the part of the counselor. During the time it takes a vocation rehabilitation counselor to place one dialysis patient, he/she could place three to four "easier" cases and thus get a higher success rate within their performance system. Thus, this is a disincentive for the counselors to accept dialysis patients. Discussions between Network staff (ED, PSC and OC) and the Regional Director of DARS are underway with a goal of developing a training protocol for rehabilitation counselors to increase their ability to work with ESRD patients. A pilot project in the North Texas region is planned for 2007.

To promote rehabilitation the Network distributes charts displaying statewide VR averages encouraging facilities to perform comparisons with their data, identify opportunities to improve, review their VR programs and implement QI if needed. The Network continues to partner with the Life Options Rehabilitation Council (LORAC) by highlighting and emphasizing their programs in mail outs, newsletters and at annual meetings. Links to LORAC materials and contact information for VR counselors are posted on the Network Web site.

Vocational Rehabilitation Centers