While dialysis in nursing homes isn't new, it remains largely underutilized across most states. Despite its infrequent implementation, it has proven tremendously beneficial in providing comprehensive care to our vulnerable population. Implementation challenges vary among states, however, dialysis is a prime candidate for auxiliary care.
Charles Minn, MD, FASN, FACP, a Washington-based nephrologist, said, “Some states are run under what we call a certificate-of-need model where the state says whether it is feasible for the area to have dialysis available.” It is important to know the regulations and guidelines in your state regarding dialysis before you reach out to any provider.
This care is growing in demand as acuity is rising in facilities, patients tend to be less stable, and hospitals are trying to minimize lengths of stay. “Hospitals are sending patients out a little bit sooner, so facilities have to stabilize them and smoothly transition them to the outpatient world,” said Minn. Without onsite dialysis at the nursing home, patients must be transported out for these services. This is risky for a variety of reasons. For instance, Minn said, “Sometimes they miss meals, and they’re usually not allowed to eat during dialysis because it sometimes leads to hypotension.”
Minn advised, “If you contact a nephrologist or nephrology group and they say they are potentially interested in providing onsite dialysis, you should be prepared to give them some education and background on what’s involved in long term care, including the kind of patients you serve, what rules and regulations you have to follow in that setting, and what kind of staff and practitioners you have. Don’t make assumptions about what they know.” At the same time, the dialysis team will want to know that they will have the full commitment of the facility itself, including the involvement of staff as needed.
Whatever equipment and care model is used, there must be communication between the state department of health, the dialysis provider, and the nursing facility. Everyone needs to be on the same page about understanding the regulations, how services will be reimbursed, and what patients are eligible to receive this care.
The benefits of onsite dialysis are significant, Minn suggested. He said, “It gives facilities a niche of patients that other facilities can’t care for, but on top of that, it can help patients who are kind of stuck in the hospital because they don't have an outpatient placement.”