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Onsite dialysis service

February 27, 2015
by Sandra Hoban, Managing Editor
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Dialysis unit

The Baby Boom has exploded! The ranks of seniors grow larger and larger each day. This generation of senior is smarter, more selective and more demanding than any generation before it. The home health market is predicted to grow as the new senior demographic opts to receive healthcare services in their homes as the need arises.

We’ve seen cocktail lounges, piano bars, golf courses and other high-end amenities added to various settings in the long-term care (LTC) spectrum. Smart skilled nursing facility (SNF) operators, however, are incorporating therapy services, such as dialysis, in their service menus to attract prospective clients.  At some point in the aging process, many boomers will find that their medical conditions will require additional support. For residents who are losing renal function, dealing with end-stage renal failure or chronic kidney disease, how appealing would it be for them to receive the proper therapy—dialysis—right where they live?


Hemodialysis can be delivered at hospitals, dialysis centers or at home. Receiving treatment is a time-consuming procedure that typically involves transporting the resident to a center, undergoing the treatment, which can last anywhere from five to six hours, and then returning to the facility. And the process is often needed three times a week.

The Centers for Medicare & Medicaid Services (CMS) has ruled that residents in long-term care can receive dialysis at a facility because it is recognized as their home, says Barbara Bednar, MHA, RN, CNN and president/CEO of Reliant Renal Care (RRC), Media, Pa. To provide onsite dialysis, Bednar, a nephrology nurse, has interpreted CMS regulations and state board of nursing regulations to develop a program that meets all requirements in the six states (Alabama, Georgia, Louisiana, Michigan, Pennsylvania and Texas) where RRC provides services. “For many years, there’s been a lack of communication between the local dialysis center and the SNF, says Bednar, adding, “We’ve crossed that bridge.”


Including a dialysis provider on your service menu doesn’t need to be an overwhelming proposition. Tim Hayes, regional director of operations for MediLodge, a Washington, Michigan-based LTC provider. “When we decided to go forward with offering dialysis services, we had to repurpose an area outfitted with sinks and closets to store equipment and supplies,” says Hayes. To accommodate four to six dialysis chairs and equipment, an area of 500–700 square feet is required. Hayes explains that converting the area at MediLodge’s Southfield (Mich.) facility was relatively easy because sinks and drains were already in place,” he explains. “We refreshed the area and RRC leases the chairs and dialysis equipment. They also order supplies and medications, which are delivered to the facility.”

The procedure room is called a dialysis den. “We try to make the areas as homelike as possible for resident comfort,” explains Bednar. Dialysis takes place in two shifts.  After the first set of residents completes the procedure, their machines are moved out and new machines are brought in for the next round of residents.

“Dialysis is covered under Medicare Part B, however, we do charge the facility a small fee to help with costs and other services we provide,” says Bednar. In return, the RRC team joins in care planning so the resident has one consistent and concise care plan. After each treatment, the SNF staff is given a summary of the treatment—including how the resident responded and if there were any problems.

RRC also conducts in-services for our staff in the facilities offering dialysis. This education enables them to  have a clear understanding of dialysis, along with the potential risks, nutritional information and recognizing signs of a problem, says Hayes. Armed with the additional knowledge, staff is more aware of the residents’ needs.


The resident is the big winner. As opposed to an all-day outing to a treatment center, the individual receives treatment at the residence and is free the rest of the day to go on outings, enjoy activities or to simply rest in his or her room. Residents don’t have to wait for transportation shuttle them to or from the local dialysis center. “Most of our residents who need dialysis receive it in the den five days a week,” says Hayes. While treatment is more frequent than three weekly visits to a dialysis center, the residents fare better because fluids and toxins are removed every day, and their kidneys function more efficiently” adds Bednar.

“Comments from residents’ families are positive,” says Hayes. Daily dialysis enables them to be more active doing the things they like to do and participating in facility life. Another plus, he adds, is that family visits are more enjoyable and frequent because the resident doesn’t have to leave the facility for treatment.


By offering onsite dialysis, the SNF reaps rewards, too. “At the facilities where MediLodge offers dialysis service, we’ve increased our census of individuals with end-stage renal disease, reduced incidents of rehospitalization and enhanced our standing in the community, giving us a competitive edge,” notes Hayes.