Marquis Health Consulting Services has made a name for itself delivering skilled nursing speciality services developed in partnership with hospitals up and down the Eastern seaboard.

But a new dialysis unit — situated in-house — has exceeded expectations weeks after opening. The unit is designed for residents with complex conditions — in addition to kidney failure. 

The nine-chair unit at Canterbury Rehabilitation & Healthcare Center in Richmond can accommodate patients who are ventilator and tracheostomy dependent. It is the first of its kind in the Richmond market, and it’s drawing interest from well beyond the region, too.

That’s because chronic kidney disease and respiratory needs overlap more often than some might expect, according to Megan Shilling, a regional director of market development with Marquis.

“We have seen exponential growth for our programs,” Shilling told McKnight’s Long-Term Care News, referring to an 18-bed vent unit that opened in winter of 2023 and the dialysis unit, which opened in February. “They have seen one of the fastest ramp-ups, not only for our ventilator and trach patients that we’re serving, but especially for those that also have a dialysis component.”

Since opening its doors three days a week, Canterbury has heard from hospitals and LTACHs in Maryland, North Carolina and West Virginia interested in accessing services for their patients. It’s now opening an additional three days a week, ahead of the original schedule, to continue meeting demand.

“There are not a lot of skilled nursing facilities that are not only stretching their capabilities, but looking at adding these types of capabilities to their centers,” Shilling said. “We’re one of the few that are.”

Dialysis in demand

Dialysis has become an increasingly popular service line for nursing homes since the Centers for Medicare & Medicaid Services in 2018 began allowing and regulating it in that setting. More than 557,000 Americans are on dialysis, and kidney disease is rapidly growing, affecting 14% of American adults, according to the American Kidney Fund. Chronic kidney disease is highly prevalent among those with diabetes; as many as one-third of those patients have CKD.

Dialysis, a process that filters out waste and extra fluid from the blood when the kidneys fail, is both time-consuming and can be life-altering. For those who need to travel from a nursing home to receive it, it can lead to missed meals, social isolation and less time receiving other needed therapies.

That reality has led to increased consumer and provider interest in in-house programs. Last week, the Accreditation Commission for Health Care introduced a Long-Term Care Dialysis Certification to assess quality; infection control before, during and after treatment; and education and training for both dialysis and long-term care staff members.

Marquis now has 14 dialysis units across its client portfolio, representing 100 dialysis chairs.

The Canterbury model

The Canterbury dialysis unit includes an isolation chair, available as needed for patients with certain infections. 

Three of the nine chairs are also able to accommodate patients with respiratory needs, many of whom have low mobility and may need to be transferred to the unit on a stretcher. The patients receive respiratory support though small, mobile ventilators and the unit was built with a piped-in oxygen supply.

Patients are seen in four shifts per day, starting at 6 a.m. and ending at 6 p.m.

The program also will accept individuals needing out-patient care, including patients who may come in as short-term, post-acute patients or who are able to go home after a stay in the facility’s chronic kidney disease management program. 

The quick and steady demand shows an important alignment with local acute providers, a hallmark of the company’s broader model, said Marquis’ Jennifer Hertzog, vice president of marketing and business development for the Mid Atlantic region.

“From the time we stepped foot into Richmond, all conversations with the regional health system and partners led us to hear, ‘It is an unmet need. There are people traveling incredible distances for this kind of care and services. Please do this,’” she recounted. “And while it took us a couple of years, the exponential growth is completely reflective of this need that we are now able to absolutely meet.”

To help ensure it can serve existing patients, continue to take more in-patient referrals and open the doors to out-patients, Marquis is looking to develop more dialysis and other specialty capabilities in the Richmond market and across the state.

“For us, we like the outpatient aspect, because if we are able to meet a patient’s [skilled care] needs at a sister location, we can still bring them to our center and still manage dialysis from that perspective,” Shilling added. “Medically, it prevents, at times, return to hospitals. This can be a huge barrier to us and managing that metric. Allowing our team to wrap their arms around that patient helps us just have a little bit more control over whether or not we feel we can manage them in-patient or if they need to return to that higher level of care.”