Where and how we provide dialysis can be an important step in keeping our most vulnerable patients safer during the pandemic
Over 1.4 million Americans reside in a skilled nursing or long-term care facility where they may receive access to round the clock care by a multidisciplinary team of nursing and allied health professionals. Of the approximately 500,000 dialysis patients in the United States, 65,000 reside in these facilities. As life expectancy continues to climb with improved treatments of cardiovascular disease, cancer and other comorbidities, a steep increase in the number of frail, elderly patients requiring both dialysis and care within a long-term care facility is expected.
There are many pathways which our parents, grandparents and partners follow which land them in long term care facilities requiring some form of dialysis. Some suffer kidney failure and functional decline after a catastrophic health event and prolonged hospitalisation. Many patients on dialysis deteriorate physically and cognitively such that their care needs exceed what we can safely provide within the home setting. There are thousands of stories of families who make the difficult decision to have their loved ones’ care transferred to these facilities where the environment is better suited to the complex needs of these patients.
The additional need for life sustaining dialysis certainly adds increasing complexity to this mix. Transportation to and from a dialysis clinic three-times a week, often in specialised vehicles accommodating wheelchairs or stretchers is often required. In times of rain, snow, extreme heat and cold our most frail and vulnerable patients make this trip for their four-hour treatments three-times per week. In dialysis facilities they wait patiently in their wheelchairs and stretchers for the spot to be ready in crowded waiting rooms, and when they come off, they wait for their pickup to return “home” once again. All of this specialised transport is estimated to cost in excess of $13,000 USD per year according to Medicare claims data.
In the midst of the 2020 COVID-19 pandemic we have been forced to think of better ways of treating these patients. About 43% of all COVID-19 related deaths have been linked to long term care facilities in the United States. All of this transportation to and from facilities, waiting for dialysis and rides home and four hours tethered to machines in close proximity to other patients renders physical distancing and isolation virtually impossible. Transporting an infected patient back to their home in a long-term care facility to mix in with other vulnerable patients is a persistent concern for which there is no immediate solution.
It is our view that virtually all routine dialysis should be available within a long-term care facility. We should bring dialysis to our most vulnerable patients, where they live, instead of packing them up in vehicles and shipping them across town. Training long-term care staff on easy-to-operate, portable dialysis devices should be the norm. This will save money, time and more importantly, protect the safety and quality of life of our frail and elderly loved ones. This is why we made the difficult decision to move them to these facilities in the first place.