Social workers bridge gaps in kidney care and community support

With the first anniversary of the California wildfires, Dr. Abilene Alcantara, a licensed clinical social worker at the DaVita Eaton Canyon facility, reflects on a time when her patients needed more than medical care; they needed stability, reassurance and support. During the wildfires, people living with chronic health conditions still required uninterrupted treatment, even as their communities faced uncertainty and loss. 

Alongside DaVita care teams, Dr. Alcantara helped ensure patients could continue their care while also connecting them with vital resources to support recovery and rebuilding. One year later, she remains a trusted source of guidance for patients navigating the long road forward.

Dr. Alcantara's interest in this field grew from firsthand experience, supporting her father through serious health challenges and seeing how difficult it was, especially for immigrants, to navigate the healthcare system. When she was just three years old, she and her family immigrated from Brazil, navigating the challenges of adapting to a new culture, learning a new language and building a new life.

“Through this experience, it led me to my passion in social work, specifically healthcare, where it allows me the ability to guide patients and families and provide them with hope and the help they may need to navigate these difficulties,” she said.

When wildfires devastated communities across greater Los Angeles last January, healthcare workers mobilized to support access to care and provide critical resources for those affected. Dr. Alcantara was part of this effort, coordinating treatment schedules, helping patients access medications, and connecting them with counseling, food assistance, and other essential services. One year later, she continues to support her patients with the same dedication.

Her ongoing work with her patients also involves planning ahead in case of a natural disaster. She works particularly with individuals who have kidney disease. “That can come with a lot of health changes and concerns, and so when your kidneys no longer work, you're not able to filter out waste and toxins, and that can affect your health,” she said.

She says it's important for patients “to navigate different complex emergency situations” in order for them to maintain their quality of care. Dialysis social workers often act as a bridge between the care team and the patients their care partner with. DaVita has an emergency protocol that they utilize during these difficult situations.

They also consistently educate patients on advance care planning and follow established protocols during natural disasters. This focus on emergency preparedness helps ensure patients can continue their care smoothly and without interruption. Additionally, they provide emergency drills and checklists so that patients feel comfortable in case they're in an emergency situation.

“Ultimately our goal is to help patients, know where they can treat, feel comfortable where they treat and continue with their adjustments and their healthcare needs. We also support patients during and after a natural disaster by periodically checking in on them especially if they're displaced or hospitalized, we wanna make sure we provide the patient and their family support, in the case that they need us,” Dr. Alcantara said. 

Social workers help ensure patients get the care they need not just for chronic conditions, but also for their overall well-being. In their role, they support patients from the time of a kidney disease or kidney failure diagnosis, making sure patients have people they can turn to and support throughout every step of their journey.

Over the last year, Dr. Alcantara has worked with a lot of Latino individuals who have expressed concerns about housing and the cost of rebuilding after the wildfires in Pasadena and Altadena. “I know that this is something that impacts not just individuals with kidney disease, but this is something that impacts the broad population; however, we try to provide support and resources, when available as things come up that we find that might be valuable to patients during this process,” she said.

More than 80,000 Californians, many of whom may have diabetes, high blood pressure, lupus or other kidney injuries, currently receive dialysis, a life-sustaining treatment for patients with end-stage kidney disease. 

There are two types of dialysis: hemodialysis and peritoneal dialysis, both of which help perform normal kidney functions, filtering waste and excess fluid from the blood. For many patients, this mandatory treatment must be done daily to be able to stay alive. According to the National Kidney Foundation, Hispanic/Latinos are 33% more likely to receive a diagnosis of kidney failure. 

For Dr. Alcantara, it is important to educate each and every one of her patients. “We want patients to really be involved in their care and understand that their input is extremely important. I educate on modality and I assist patients in the transplant process,” she said. “I also help with providing support for mental health services and any other support patients and families might need. So we really act as a bridge between the patient and the healthcare system.”

DaVita social workers suggest that any individual with kidney disease be prepared when it comes to an emergency evacuation or warning. They recommend that kidney patients on dialysis add the following items to their emergency kit bag:

• Emergency phone numbers for doctors and dialysis centers, including alternate nearby centers.

• At least three days’ worth of any medicines needed, as well as a list of medicines and the dosage amounts.

• For patients with diabetes, a week’s worth of supplies (syringes, insulin, alcohol wipes, glucose monitoring strips).

• At least three days’ worth of emergency food.

“Emergency planning can sound a lot scarier than it really is so having a basic plan can bring you a lot of peace of mind, so the goal is not to be perfect, but rather to just be prepared,” Dr. Alcantara said. She also says she likes to “encourage patients to use available resources” such as the dialysis healthcare team, social workers and any other organizations that support their care.