I have a patient with Kaiser insurance and on PD. She has been too ill to work and wants to apply for disability. She is hoping to go back to work after about 6 months of rest. What is the best thing, state disability (CA) or SSDI? Thanks!

One of the requirements to receive Social Security Disability Insurance (SSDI) in addition to having the right number of work credits is that the impairment is expected to last at least a year or result in death. Social Security can find someone who is on dialysis eligible for SSDI, but there is a qualifying period during which someone hasn’t performed “substantial gainful activity” for 5 months and the first check won’t be received for another month. There is no retroactive payment for the qualifying period, although if someone hasn’t worked for longer than that due to a qualifying impairment, SSA can backdate the date the work impairment started and pay retroactively for any months since the qualifying period ended.

If she is eligible to take time off under the Family and Medical Leave Act she could get paid her salary for any unused vacation or sick days even for incremental periods if she works part-time. Using FMLA protects her rights to promotions, salary increases, etc. and also requires the employer to allow her to keep her health coverage even if she has to pay for it. If there is state disability, that may provide some limited funds to help her pay her bills, but it’s likely to be significantly less than what she is earning from work. Even SSDI only pays around 35% of the average individual worker’s wages. She can find out what she would get from SSDI by looking at her annual statement from Social Security or calling Social Security toll-free at 1-800-772-1213. Living on disability usually requires major adjustments in lifestyle that can be financially devastating and depressing and yet once someone starts receiving disability benefits they may be emotionally difficult to give up to return to work.

Is there any possibility that her health status could be improved by adjusting her dialysis prescription, promoting healthy lifestyle and behavior changes, and working with her employer if she’s getting pressure at work?

Since the patient has an unstable employment status, this could trigger the patient as psychosociallly unstable. Conducting a full interdisciplinary team patient assessment and plan of care may identify work limiting factors that could be corrected so she could feel healthy enough to continue working. Some possible things to consider include:
[li]Is the type of PD she’s doing removing enough toxins?
[/li][li]Is her blood pressure and fluid removal appropriate?
[/li][li]Are other health conditions well controlled?
[/li][li]Are her prescribed medications effective and do any have side effects that may be barriers to working?
[/li][li]Does her nutritional status indicate a need for nutritional education/counseling?
[/li][li]Does she have depression or other psychosocial needs that the social worker could address?
[/li][li]Has she been physically inactive so that she has become debilitated requiring a physical rehabilitation referral or education about safe exercises?
[/li][li]What steps does she plan to take to become more work ready at the end of 6 months?

Here is the list of Social Security publications on disability benefits: