The kidney failure crisis in the United States is an under-discussed tragedy. In 2018, 786,000 Americans were living with ESRD (end-stage renal disease). While the healthcare industry chooses to focus on the needs of active, middle-aged dialysis patients, the truth is that 80% of ESRD patients are 65 or older. Many are nursing home residents, who deserve better kidney dialysis treatments.
While a functioning kidney transplant is the best treatment for ESRD, that option is not available to all patients. 70% of patients with ESRD undergo dialysis. Dialysis is a treatment that imperfectly replaces kidney function for those with compromised kidneys. Many ESRD patients need this treatment every few days to stay alive and healthy. Despite the regular need for the treatment, only 14% of dialysis takes place at patients’ homes. The rest is done at an outpatient clinic.
Outpatient clinics are inconvenient for nursing home residents for several reasons. These locations are not designed around the needs of nursing home residents. For residents who cannot transport themselves, transportation is disruptive, confusing, and time consuming. Highly acute residents often struggle to find placement at outpatient clinics due to their extra health risks, yet they deserve treatment as much as any other patient.
Both residents and nursing homes benefit from the offering of on-site dialysis treatment. The treatment does not have to change aside from location, allowing the drawbacks discussed above to be eliminated. Onsite dialysis frees up hours of travel time per week, giving residents more time for therapies and social activities. On the side of nursing home operators, facilities with on-site dialysis can accept higher acuity patients than those without. While installing and maintaining dialysis on-site can be an investment, providing ambulance transportation for outpatient kidney dialysis may cost nursing home operators up to $411 per round trip. Nursing homes nationwide aspire to offer better care at a lower cost.
In choosing the type of dialysis treatment to offer, 3-day dialysis easily wins out over daily. 98% of nursing home patients are already accustomed to 3-day dialysis from their experience with outpatient treatment. Switching to daily would require prescription changes. Such changes may cause confusion and disrupt the resident’s continuity of care. Daily dialysis carries a greater risk of potentially leading to hospitalization or surgery due to the higher risk of difficulty with blood-access sites, blood clots, and aneurysms. Asking for daily treatments also increases the possibility of missed treatments.
While patient care is the primary consideration, nursing homes must also keep an eye on cost. Here again, 3-day dialysis proves superior to its daily counterpart. For the same initial investment, on-site, 3-day dialysis provides treatment to 3 times more patients than daily dialysis. Imagine a nursing home has 6 chairs specially designed for dialysis treatment. 3-day dialysis can support up to 36 patients. Meanwhile, daily dialysis can support only 12 patients. Better care, lower cost. The best combination a nursing home can ask for.
Large dialysis providers fail to deliver effective, flexible treatment for geriatric patients. It’s time a new model came into prominence.