Creating a dialysis-friendly facility
Dr. Eleanor Barbera
Studies show there will be an increasing number of people on dialysis in the coming years. It's likely many of them will be in long-term care.
There is much that can be done to improve the quality of life for these individuals and to showcase your facility as dialysis-friendly. Unfortunately, many providers are not doing all they can to help these people, or boost their own business operations, for that matter.
New diagnoses of end-stage renal disease (ESRD) in residents should prompt a team discussion with them and their families about wishes for end-of-life care (see Dialysis: Gauging its need, and how to reduce its stress). Some may prefer to avoid dialysis, but many of the newly diagnosed will choose to begin dialysis treatments. In addition, most facilities already have residents committed to the ongoing process of dialysis.
To understand how to best improve care, let's consider what life is currently like for many hemodialysis patients in long-term care.
A week in the life …
Most people undergoing hemodialysis leave their LTC facility three days a week in order to receive treatments that last for about 3 ½ to 4 hours. In the case of James, for example, he is awakened at 6:30 a.m. to get ready for a 9 a.m. pickup for a 10 a.m. dialysis appointment. He spends the day dozing on and off in front of the television while hooked up to the dialysis machine. By 2 p.m., he's disconnected from the machine and has a 2:30 p.m. pickup time that sometimes doesn't happen until 3 p.m. He's back at the facility by 4 p.m.
Not surprisingly, James and other residents are frequently fatigued on the days in between treatments, making it less likely they're able to participate in rehab or in the life of the LTC community.
A typical dialysis patient has interacted for hours with an entirely different staff that generally has little contact with the facility care team. They've been on an ambulette dealing with various personalities in close quarters (and possibly in traffic or bad weather) and it's likely that lunch was a renal diet sandwich eaten while being dialyzed.
Considered from a “patient experience” perspective, the bar is set pretty low and there's a lot we can do to raise it.
Options for enhancing care range from thoughtful tweaks to changing the type of dialysis program provided. Here are some ideas to improve life for those on dialysis:
* Consider offering peritoneal dialysis. Hemodialysis uses artificial kidney machines to clean out the blood, but in peritoneal dialysis “the inside lining of [the] stomach acts as a natural filter. Wastes are taken out by means of a cleansing fluid called dialysate, which is washed in and out of [the stomach] in cycles.”1 This enables the process to occur at night while the patient is sleeping and eliminates many of the problems noted above. For more information, read “The Development of a Peritoneal Dialysis Program in the Skilled Nursing Facility.”
* Offer daily in-house dialysis, which eliminates the need for travel, reduces diet restrictions and decreases the amount of time needed for each treatment session.
* Schedule services such as banking hours and the hair salon so that those attending off-site dialysis programs can take advantage of them.
* Individualize rehabilitation schedules so that they make use of the resident's least fatigued part of the day and week.
* Increase communication between the dialysis center and the long-term care facility, particularly in the case of residents who are resistant to attending dialysis or have other behavior concerns. Consider having an occasional video call so that staff members are familiar with each other and increase contact as needed to discuss difficult cases.
* Be aware that a great deal of time each week is spent in transportation and with ambulette drivers and other passengers. Some oversight of the transportation process may be needed, such as a staff member to assist residents in leaving from and returning to the facility, or regular contact with the ambulette company to ensure quality service.
* Enable residents to learn about and purchase dialysis-friendly clothing, which allow access to ports without the need to partially disrobe.
* Make lunches pleasurable. Remember that feeling when Mom put something special in your lunchbox if she knew you were having a hard day? Enough said.
* Help residents make the most of their dialysis time. While many people prefer to sleep or relax during dialysis, others will appreciate activities that keep them connected to the community while they're away. For instance, seek-a-word books, a lending library and iPod shuffles with favorite music could be made available specifically for dialysis patients.
* Educate residents about the larger dialysis community, helping them feel less isolated and more in control of their lives. The National Kidney Foundation and the Renal Support Network provide information and support for individuals on dialysis and their families, while Dialysis Patient Citizens is a patient-run organization that focuses on advocacy.
Residents on dialysis are on it for life. A few small shifts in philosophy and scheduling can make a huge impact in improving their experience of dialysis in your organization and a commitment to onsite dialysis can dramatically enhance their lives.
Eleanor Feldman Barbera, PhD, author of The Savvy Resident's Guide, is a 2014 Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is the Gold Medalist in the Blog-How To/Tips/Service category of the 2014 American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with nearly 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.