Community dialysis options for bed bound individual


#1

Hi, I have a patient that we are struggling to find a community dialysis chair for. He is currently unable to ambulate or move without assistance. I was wondering what options there are for this person to receive dialysis in the community. He has been denied from all long term care facilities. Looking for other options. Thanks!


#2

When a patient has kidney failure, needs and desires to get dialysis, is bedbound and unable to sit, it may be best for that patient’s comfort to get dialysis in a bed. Most dialysis facilities have recliner chairs, not beds. However, in a skilled nursing facility that offers on-site dialysis or to get dialysis in a long term acute care (LTAC) facility the patient should be able to dialyze in a bed. States collect data on certtified and licensed facilities. State survey agencies should have records of which SNFs and LTALCs in your area offer hemodialysis or peritoneal dialysis on-site. You can find a 2018 list of regional and central office contacts as well as 2017 list of state survey agency contacts on this CMS page.
https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/ContactInformation.html

You say that this patient has been denied admission at all long term care facilities. Have you been told why? You may want to talk with the state survey agency long-term care section contact about this so s/he can determine if any there is a possible violation of the nursing home regulations.

Finally, some patients who have kidney failure choose not to get dialysis and to instead get conservative management of their kidney failure, which may include palliative care or hospice care. Unfortunately, too often doctors don’t always discuss this option with patients and their families, including how the patient’s symptoms can be managed. Dialysis can be burdensome to patients.


#3

Thank you for the reply. The family does not want to apply for LTC MA, but he does not have any skillable needs for SNF.


#4

Is the family aware of Medicaid rules that protect spouses from becoming impoverished (spousal impoverishment)? Sometimes knowing that their loved one can get the care s/he needs while the spouse can remain in the home and keep some income and assets can make the decision to place in LTC a little easier. https://www.medicaid.gov/medicaid/eligibility/spousal-impoverishment/index.html

Another option…If the family is willing to learn how to do home hemodialysis or peritoneal dialysis or to pay someone to do it for them, the patient could go home and get dialysis in the comfort of home. It does take time to learn and a commitment on the part of someone who chooses to be a care partner. Here’s an article about becoming a home dialysis care partner. https://www.homedialysis.org/life-at-home/articles/should-you-become-a-home-dialysis-care-partner

Here’s a page with some tips and tools for care partners. https://www.homedialysis.org/life-at-home/care-partners