What is On-Site Home Hemodialysis?
A Growing Opportunity
End-Stage Renal Disease (ESRD) Patient Population in Nursing Homes
Challenges with the current dialysis care model at SNFs have supported the growing movement towards a more patient-centric approach.
Clinical Challenges
Dialysis residents that receive traditional off-site in-center hemodialysis treatments may struggle with hemodynamic or cardiovascular instability associated with longer, conventional hemodialysis treatments.
Conventional hemodialysis at a dialysis center may also be associated with longer post-dialysis recovery times and lower energy levels, which can cause dialysis residents to miss meals, rehabilitation, and social activities.10
Economic Challenges
Residents being treated at a dialysis center will likely require round-trip transportation three times a week to their clinic. This can be stressful for them and costly for SNFs. Economic challenges to consider when managing dialysis residents include:
- Average roundtrip cost of transportation
- Hours spent scheduling, coordinating, and transporting
SNFs are looking for unique competitive differentiator services to potentially improve occupancy and referrals.
Operational Challenges
The complex care required by SNF dialysis residents can result in organizational, staffing, scheduling, and communication difficulties between the SNF and the dialysis clinic. When transportation is added to the equation, a three-way communication challenge presents itself, increasing the possibility for confusion, delays, and/or schedule changes. When a dialysis resident’s schedule is compromised, they may miss meals or scheduled medications, which is detrimental to their health and wellbeing.
On-Site HHD - A Care Model for Success
Benefits of On-Site HHD
Benefits of On-Site Home Hemodialysis (HHD)
Residents performing more frequent HHD on-site in a SNF have shown improvements in both survival and hospitalizations.4 In addition, more frequent hemodialysis in the general population is associated with:
- Less risk of cardiovascular hospitalizations5
- Improved post-dialysis recovery time6
- More energy & vitality7
- Reduced antihypertensive medications8
- Improved survival9
In addition, a SNF On-Site HHD program allows a SNF the potential to increase referrals as well as decrease dialysis-related transportation expenses.3,10
Effective Care Partnerships
Effective Care Partnerships3
Effective on-site HHD programs rely on strong partnerships between dialysis providers and SNFs. Below are some roles and responsibilities to consider.
Skilled Nursing Facilities
- Identify treatment space for dialysis
- Cover expenses for basic utilities (water and electricity)
- Determine dedicated secure areas for equipment, supplies, and medications
- Cover labor costs for staff-assisted dialysis (care-giver fee)
- Receive and handle supplies delivered by courier
Dialysis Providers
- Oversight of the home dialysis program (Med Director, Nurse Manager, etc.)
- Manage dialysis equipment and supplies
- Provide medications and labs associated with dialysis
- Handle billing and reimbursement associated with dialysis treatments
Shared Responsibilities (between SNF and dialysis provider):
- Policies and procedures – e.g. emergency planning, infection control
- Coordinated patient care plans
- Caregiver and staffing
CMS requires a formal coordination of care agreement between the SNF and the dialysis provider when ESRD patients are residents in the SNF.
Considerations for
Implementing a Program
Considerations for Implementing a Program
With over 11,000 patients worldwide in the home environment,11 the NxStage HHD system is the practical dialysis therapy for the SNF environment.
NxStage provides individualized treatment options to meet the clinical needs of patients, which may translate to success maintaining rehabilitation, medication, meal, and activity schedules.
Designed for Success
NxStage offers the following advantages over traditional equipment in a SNF setting, including:
- Minimizes requirements for plumbing and electrical alterations
- Eliminates chemical disinfection cycles
- Minimal changes required to existing plumbing and electrical wiring
- Eliminates maintenance of RO water treatment
- Lowers utility costs12,13
- Smaller treatment space
Resource Center
Home Hemodialysis Near You
Despite the health benefits that more frequent home hemodialysis may provide to those with chronic kidney disease, this form of therapy is not for everyone.
The reported benefits of home hemodialysis may not be experienced by all patients.
The NxStage System One is a prescription device and, like all medical devices, involves some risks. The risks associated with hemodialysis treatments in any environment include, but are not limited to, high blood pressure, fluid overload, low blood pressure, heart-related issues, and vascular access complications. The medical devices used in hemodialysis therapies may add additional risks including air entering the bloodstream, and blood loss due to clotting or accidental disconnection of the blood tubing set. When vascular access is exposed to more frequent use, infection of the site, and other access related complications may also be potential risks. Patients should consult with their doctor to understand the risks and responsibilities of home and/or more frequent hemodialysis using the NxStage System One.
Patients and providers are encouraged to contact their state regulators to discuss state-specific regulations that may impact dialysis in the Skilled Nursing Facility setting.
References:
- 2019 USRDS Annual Data Report Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2015.
- DataDialysis.org. FY2017 Dialysis Facility Report Data. 3. Yang A, Lee WY, Hocking K, Xelay Acumen, Inc., Affiliated Dialysis. Survival comparison of daily home hemodialysis vs conventional dialysis in the nursing home setting. Nephrology News & Issues. February 17, 2015.
- Data on File. NxStage Medical, Inc. Health Advances Interviews. March 2020. Based on interviews with 9 facilities.
- Weinhandl E, Hocking K, Markovich S, Vavrinchik S, Collins A. Increased Hemodialysis Frequency is Associated With Improved Clinical Outcomes Among Patients in Skilled Nursing Facilities. Abstract presented at ASN 2018.
- Weinhandl ED, Nieman KM, Gilbertson DT, Collins AJ. Hospitalization in daily home hemodialysis and matched thrice-weekly in-center hemodialysis patients. Am J Kidney Dis., 2015;65(1):98-108.
- Jaber BL, Lee Y, Collins AJ, et al. Effect of daily hemodialysis on depressive symptoms and post dialysis recovery time; interim report from the FREEDOM (Following Rehabilitation, Economics and Everyday-Dialysis Outcome Measurements) Study. Am J Kidney Dis. 2010;56(3);531-539.
- Finkelstein FO, Schiller B, Daoul R, et al. At-home short daily hemodialysis improves the long-term health-related quality of life. Kidney Int. 2012;82(5);561-569.
- FHN Trial Group. In-center hemodialysis six times per week versus three times per week. N Engl J Med. 2010;363(24);2287-2300.
- Weinhandl ED, Liu J, Gilbertson DT, Ameson TJ, Collins AJ. Survival in daily home hemodialysis and matched thrice-weekly in-center hemodialysis patients. J Am Soc Nephrol. 2012;23(5);895-904.dol:10.1681/ASN.2011080761.
- Data on file. NxStage Medical, Inc. Healthcare Advances Interviews. May 2013. Based on interviews with 5 facilities.
- Data on File. NxStage Medical, Inc. July 2020.
- In-center water calculations based on 500 mL/min DFR, 220 minute treatment, 109 L of dialysate per treatment, 3 treatments per week. This simulation uses a 3:1 ratio for RO systems
- Home hemodialysis calculations based on 190 mL/min DFR, 30 L, 158 minute treatment, 30L of dialysate per treatment, 5 treatments per week. This simulation uses a 1:1 ratio for DI systems
