Dialysis in Nursing Homes – Innovating a Trend

Kidney failure is a crisis in the United States, especially among aging populations.  Of the 786,000 Americans living with ESRD (end-stage renal disease), 80% were 65 or older in 2018.  That same year, Medicare spending on dialysis and kidney transplants reached $49 billion.  The effects of this problem are vast and widespread.

86% of dialysis done today occurs in outpatient clinics.  This is difficult for many older people to handle, especially those who live in nursing homes.  Outpatient dialysis clinics are not designed to accommodate them.  The treatment poses an infection risk, transportation there is disruptive and time consuming, and highly acute patients can struggle for placement at these clinics.

If nursing homes were to offer on-site dialysis, they would be able to accept higher acuity patients while eliminating transportation costs.  On-site, 3-day dialysis eliminates outpatient drawbacks.  98% of nursing home dialysis patients are already accustomed to 3-day dialysis anyway, so continuity of care would benefit them.  

3-day dialysis also wins out over daily dialysis.  3-day dialysis requires 17% less treatment time than daily dialysis does.  Furthermore, daily dialysis carries a greater risk of complications, which could lead residents to needing hospitalization and surgery.  Another reason to use 3-day dialysis instead of daily is coverage; for the same initial investment, on-site, 3-day dialysis provides treatment to 3 times more patients than daily dialysis could.  Large providers have failed to deliver effective, flexible treatment  for nursing home residents.  Need exists for a different model, one that accounts for patient needs.

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