When it comes to health crises in the United States, kidney failure is not always talked about. Yet it is a serious problem for hundreds of thousands of Americans; 786,000 people in the US were living with end-stage renal disease (ESRD) in 2018. During that same year, Medicare spending on patients suffering from ESRD reached $49 billion. Because only 30% of ESRD patients are lucky enough to receive functioning kidney transplants, most of this money went into dialysis treatment.
Who are the Americans that rely on dialysis to stay healthy? The answer may surprise you. For a long time, the healthcare industry has focused on the needs of active, middle-aged dialysis patients. These patients are the face of ESRD, but they are not the majority. 80% of patients with ESRD are age 65 or older. Many of them are nursing home residents.
Provision of dialysis is not designed to accommodate nursing home residents. 86% of dialysis treatment occurs in outpatient clinics. Patients must travel every few days to a clinic for treatment they need to live. In the case of nursing home residents, this travel can expose them to infectious diseases. When the resident is exposed, they carry the disease back with them for nursing home staff and other residents to encounter as well. Traveling to a dialysis clinic can also be disruptive, confusing, and time consuming for elderly patients, many of which cannot transport themselves. Making matters worse, not every ESRD patient may be seen by an outpatient clinic. Higher acuity residents often struggle to find placement at outpatient clinics.
Nursing homes should offer on-site dialysis. Such an offering would benefit not only the resident, but the nursing home operators as well. On-site dialysis eliminates hours of travel time per week for the residents that use it. This leaves residents with more time to partake in therapies or other social activities. In-house dialysis also decreases the risk of outside infections coming into the nursing home.
On the side of the operators, on-site dialysis puts their facility at the forefront of clinical innovation. It gives them better collaboration of care, fewer hospital readmissions, and stronger relationships with hospital partners. Nursing homes able to offer on-site dialysis can accept higher acuity patients into their facility than those who lack the treatment option. Furthermore, even though installing on-site dialysis is an investment, nursing operators have the potential to save money in the long run. Transportation costs to dialysis clinics can be a burden. Providing ambulance transportation for outpatient dialysis may cost nursing home operators up to $411 per round trip.
Once a nursing home has chosen to provide on-site dialysis to their residents, they need to choose between 3-day dialysis and daily dialysis treatment. 3-day dialysis is the superior choice on multiple fronts. For one, it is the dialysis type that nursing home residents are already used to. 98% of dialysis patients who live in nursing homes are accustomed to 3-day outpatient dialysis. Switching them to daily dialysis requires changes in their prescription. Changes could generate confusion or disrupt the continuity of care.
Beyond being convenient, 3-day dialysis is also safer than daily dialysis for the patient. Daily dialysis carries greater risk of potentially leading to hospitalization or surgery. Complications whose risk increases with daily dialysis includes difficulty with the blood-access site, aneurysms, and blood clots. With greater treatment frequency also comes a greater risk of missed treatments, and that carries its own set of risks.
While nursing home operators care a great deal about quality of care, they must also concern themselves with the cost of the services they offer. In the financial realm, 3-day dialysis also wins out over its daily counterpart. For the same initial investment, on-site, 3-day dialysis provides treatment to 3 times more patients than daily dialysis is able to. For example: if a facility had 6 dialysis chairs and used 3-day treatment, they could support up to 36 patients. If the same facility used daily dialysis instead, they could only support 12 patients. Greater care at a lower cost is the goal of all nursing homes.
Large dialysis providers have not provided effective, flexible treatment to geriatric patients. It’s time a new model took over.
