Improving kidney care for residents in nursing facilities

Barbara Bednar
Barbara Bednar

Dialysis is a life-sustaining treatment for people who have lost the function of their kidneys. The leading cause of kidney failure is type 2 diabetes. The numbers of people starting dialysis are increasingly from older age groups. In 2012, 55,419 new patients starting dialysis were over 65 years of age, which represented 48% of all new patients.  

Traditionally, residents within nursing facilities requiring dialysis are transported to a local dialysis center three times per week for treatment. The residents are transported in all weather conditions and are out of their “home” for up to six hours per treatment day. The residents often miss meals, medications and social interactions. If the resident was admitted for rehabilitation services, their physical, occupational and speech therapy is missed or shortened.

Reliant Renal Care, Inc. began to offer staff-assisted hemodialysis to residents within nursing facilities in 2013. The RRC team includes nurses, patient care technicians, social workers, renal dietitians, and nephrologists. Using RRC's certified, highly experienced staff, the residents needing dialysis receives short time dialysis five times per week. Each resident is assigned their own dialysis machine.  Since the beginning of the program, RRC has treated more than 280 residents within their nursing facility.

This care model has produced better clinical outcomes for dialysis residents in nursing facilities. The hospitalization rate declined from 4.2 admissions per patient per year to 3.1 admissions per patient per year, a 28% decline over a 10-month period. Likewise the re-admission rate for the 10-month period was decreased to 21%. Demographic data collection of all 280 residents indicates the 26% of this group were admitted to a nursing facility with less than 3 months of dialysis therapy. This may suggest that elderly people needing dialysis are being discharged from the hospital directly to a nursing facility more frequently.  

The most demonstrative improvement is with the residents themselves. No more transportation services in all types of weather. Most residents see a reduction in the number of medications they need to take. Their energy levels increase because they are receiving frequent short time dialysis sessions. Food and fluid restrictions can be reduced as well. Most importantly, the dialysis treatment can be scheduled around the resident's activities instead of the dialysis center's schedule.

It is anticipated that by 2025, the number of people needing some type of nursing care will have increased by more than 20%. Consequently, more medically complex residents will be admitted needing dialysis therapy. By offering mobile dialysis services within a nursing facility, additional residents needing dialysis can be admitted and treated on site. Transportation expenses are decreased or eliminated. Rehabilitation services can be provided as ordered and the residents benefit by better clinical and quality of life outcomes.

Barbara Bednar MHA, RV, CNN is CEO of Reliant Renal Care, Inc.

 

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