Personal care treatments

The shift from community dialysis to “home” treatment in skilled nursing facilities

As our population ages and the number of people with complex medical conditions increases, so does the number of people with kidney failure: end-stage renal disease (ESRD). By 2022, more than 500,000 people in the United States will need dialysis to survive. Of these 500,000, an ever-increasing number of advanced age, frailty, and multiple comorbidities may require increasingly complex care in a skilled nursing (SNF) setting.

In fact, up to 15% of the dialysis population will reside in a SNF at some point in any given calendar year, some of whom will become long-term residents and others who will be post-acute hospital care at short term. residents. Given the specialized needs of this growing population, patient-centered care will more than ever be a critical part of the rapidly evolving model of care for the nursing home dialysis population.

Historically, dialysis patients residing in a nursing home were transported to and from a community dialysis facility for dialysis therapy. In 2021, realizing the benefits of on-site hemodialysis in nursing homes, CMS released updated state operations manual guidelines for providing dialysis services to SNF residents under “ home”. These guidelines have provided detailed information on the delineation of responsibilities between the dialysis program and the SNF, the collaborative development of policies and procedures, the coordination of care between the dialysis program and the SNF, and many other topics. important.

In this context, the dialysis services provided on site in EHPADs are about to enter a growth phase. And while there are indisputable benefits in eliminating the cost and risk of transporting patients off-site for dialysis services, until very recently the fundamental choice of technology to meet the particular needs of the population care homes has not been addressed.

The critical and pragmatic steps involved in developing equitable, patient-centered care for nursing home patients came only very recently when medically advanced home hemodialysis therapies were reoriented and modified for use in nursing homes. elderly and frail people in dialysis patient populations in retirement homes with multiple complex medical comorbidities. challenges.

Home hemodialysis therapies typically involve the use of a different type of hemodialysis technology, using a more frequent, more effective, yet gentler form of therapy that increases survival, reduces hospitalizations, and dramatically improves quality of life. The private home population has always been much younger and healthier than the nursing home population. Private home dialysis has always been self-administered, usually with the help of a family member.

Modifications to some technical aspects of the home dialysis machine and the use of professionally trained dialysis personnel as caregivers have produced a paradigm shift in the personalization of care from the conventional approach to dialysis care. . The use of a collective treatment setting, a “den” that can accommodate up to 6 patients treated simultaneously, makes the shared use of professional staff practical and contributes to the financial feasibility of the model.

In addition, the new model directly addresses the issue of equity in health care. Private home hemodialysis is underrepresented with respect to the elderly, frail people of color and lower socioeconomic status. Such a disparity does not exist with the new model of care. Every patient is now offered the chance of a longer and better life with more effective and gentler treatments.

When modified appropriately for the elderly population, unlike the 8-21 hour recovery times of conventional therapy, over 90% of the nursing home dialysis population recovers from dialysis treatment in every two hours, resulting in a profound improvement in functionality and quality of life. . Over the next 5 years, this new model will become the standard of care for the nursing home patient population. It’s the least we can do for our seniors.

Photo: Edwin Tan, Getty Images