Home-based hemo-dialysis in a SNF

I am interested in providing home-based hemo-dialysis for patients on ventialtors residing in a sub-acute unit of a SNF. The facility is located in Midwestern Pennsylvania. Does any one have information on this or is anyone interested in discussing the provision of this type of dialysis in a SNF? Thank You.
Philip E. Tack, NHA
Sugar Creek Rest
120 Lakeside Drive
Worthington, PA 16262
phone 724-445-3000
fax 724-445-7354

Hemodialysis can be done in a SNF. CMS has instructions for how to do this on MedLearn with links in the document at www.cms.hhs.gov/medlearn/matters/mmarticles/2004/SE0435.pdf.

In the last year I have responded to two phone calls from family members of ventilator-dependent patients. Both would have loved to have had their loved ones at home. One patient was in an acute hospital for longer than necessary because a skilled facility could not be found that was willing to dialyze the patient. The other was dialyzing in a step-down unit in a hospital. I think if the family member could have been trained to do dialysis on the patient or if there was staff-assisted home dialysis nearby they would have done that. I don’t know how often this service is needed, but when it is – either in a quality nursing facility or at home – it is really appreciated.

Thanks for the information and back ground. We are still looking for a way to provide hemo-dialysis in-house. If any one else is supplying hemo-dialysis in a SNF I would like them to get in touch with me. Thanks Again!
Phil Tack

We have provided staff-assisted hemodialysis in SNF’s in Massachusetts. A benefit exception was negotiated from the patient’s commercial insurer to pay for the caregiver, and because the SNF is legally the patient’s residence we billed Medicare B under Method II.


Since we are a “chronic” home hemo dialysis provider we constantly worry about crossing the line to “acute” dialysis among our SNF population. We have provided home hemo in SNF setting to vent patients but the vent patients must be medically stable and responsive. we require that a respiratory therapist be present to address vent related issues.

Unfortunately many sub acute vent hospitals are trying to “dump” these patients to SNF. They can be extremely unstable - before we established our criteria we had accpeted patients who died in transport from teh subacute hosp to the SNF and from the SNF floor down to the dialysis area.