In a growing crisis, hundreds of thousands of Americans are living with failed kidneys.  In 2018, 786,000 US citizens were living with ESRD (end stage renal disease).  Also in 2018, total Medicare spending on ESRD patients reached $49 billion, with the majority of that money going to the provision of dialysis.  A functioning kidney transplant is the ideal cure for ESRD, but not all those in need can receive one.  70% of patients with ESRD must undergo dialysis.

For too long, the industry has focused on the needs of active, middle-aged dialysis patients.  86% of all dialysis occurs at outpatient clinics, which are risky and inconvenient for senior citizens who require their services.  Despite industry perceptions, 80% of patients living with ESRD are 65 years old or above. Many of these patients live in nursing homes, meaning they have limited transportation opportunities and live in large groups vulnerable to contagious disease.  Traveling to a dialysis clinic is disruptive, time consuming, and can risk the health of the patient or other nursing home residents.  The most highly acute residents struggle to find placement at outpatient clinics.

Nursing homes need on-site dialysis.  Providing this service can save residents hours of travel time per week, giving them more time for therapies and other social activities.  For nursing home operators, those with on-site dialysis can accept higher acuity patients than those without.  In addition, on-site dialysis lets nursing homes save up to $411 per trip in transportation costs.  

In choosing the type of dialysis to provide, nursing homes should opt for 3-day dialysis over daily.  98% of nursing home patients are already accustomed to 3-day treatments.  Switching to daily would require prescription changes, which cause confusion and may disrupt continuity of care.  Daily dialysis also carries greater risk of surgery or hospitalization due to the higher chances of difficulty with the blood-access site, blood clots, and aneurysms. 

On top of being better for the patient, 3-day dialysis also saves nursing homes money.  Quality of care should be a facility’s first priority, but no operator can afford to ignore costs.  For the same initial investment, on-site, 3-day dialysis provides treatment to 3x more patients than daily dialysis would.  With 6 dialysis chairs, nursing homes can serve 36 patients with 3-day dialysis or 12 patients with daily.  The choice is clear: both caregiver and patient benefit when 3-day dialysis is offered inside the nursing home.

Dialysis in Nursing Homes