As our population ages and the number of people living with a complex disease increases, so does the number of people living with kidney failure: end-stage renal disease (ESRD). By 2022, more than 500,000 people in the United States will require dialysis treatment to survive. Of these 500,000, increasing numbers of advanced age, frailty and multiple comorbidities may require more complex skilled nursing facility (SNF) care.
In fact, up to 15% of the dialysis population will live in an SNF at some point in a given calendar year, some of whom will become long-term residents and others as short-term post-acute hospitalization residents. Given the specific needs of this growing population, patient-centered care is more than ever a critical component of the rapidly evolving care model for the nursing home dialysis population.
Historically, dialysis patients residing in nursing homes were transported to and from community dialysis facilities for dialysis treatment. In 2021, CMS, recognizing the benefits of on-site hemodialysis in nursing homes, issued updated guidance to the State Operations Manual to provide dialysis services to SNF residents in a “home” setting. These guidelines provide detailed information on the division of responsibilities between the dialysis program and the SNF, collaborative development of policies and procedures, coordination of care between the dialysis program and the SNF, and many other important topics.
Against this backdrop, on-site dialysis services in nursing homes are expected to enter a growth phase. While eliminating the cost and risk of transporting patients off-site for dialysis services is undoubtedly beneficial, until recently the fundamental options for technology to meet the specific needs of the nursing home population remained unresolved.
The critical, pragmatic steps involved in developing equitable patient-centered care for nursing home patients have only recently emerged, when medically advanced home hemodialysis therapy was repurposed and modified for use in patients with multiple complex comorbidities. Aged, frail nursing home dialysis patient population challenges.
Home hemodialysis therapy typically involves the use of different types of hemodialysis techniques, with more frequent, more effective, but gentler forms of treatment that can improve survival, reduce hospitalizations, and greatly improve quality of life. The private household population has historically been much younger and healthier than the nursing home population. Private home dialysis has historically been self-administered, usually with the help of a family member’s carer.
Modifications to certain technical aspects of home dialysis machinery and the use of trained dialysis professionals as paramedics have produced a paradigm shift in customized care compared to traditional dialysis care methods. The use of a centralized treatment environment, a “ward” that can treat up to six patients simultaneously, makes shared use of professionals practical and contributes to the financial viability of the model.
Furthermore, the new model directly addresses health care equity. Private home hemodialysis is underrepresented among older adults, frail individuals of color, and individuals of lower socioeconomic status. The new model of care does not have this difference. Every patient now has the opportunity to live a longer, better quality of life with more effective, gentler treatments.
When appropriately modified for the elderly population, more than 90% of the nursing home dialysis population recovered from dialysis treatment within two hours, resulting in significant improvements in function and quality of life, as opposed to the 8-21 hour recovery time of conventional therapy. Over the next 5 years Inside, this new model will become the standard of care for the nursing home patient population. This is the least we can do for our elders.
Photo: Edwin Tan, Getty Images
