I was wondering if there are any guidelines out there regarding whether home visits are required for RDs and SWs for home hemo or PD patients. If so, do they state how frequent they should be? Thanks.
Medicare’s ESRD Conditions for Coverage (regulation) discusses home visits, but does not require personnel of the facility to do them if the facility can effectively provide a home dialysis patient support services without them.
In my experience, home training nurses often visit the home to be sure that the setting will work for home dialysis equipment and supply storage, to help the patient decide where to dialyze, and to determine with biomedical personnel what home modifications may be needed.
A social worker and dietitian can use a home visit to talk with the patient in his/her home setting where he/she may feel more comfortable and to see first-hand the patient’s living situation to more accurately evaluate the patient’s environment, support, and needs.
However, some patients have refused home visits by staff. If that happens, the facility must decide whether the patient’s right to privacy supersedes the responsibility of the facility to assure that the home is a safe setting for home dialysis.
Here are pertinent sections from the current ESRD Conditions for Coverage.
Section 405.2137(b)(6) which discusses long term program and patient care planning states:
I For a home–dialysis patient whose care is under the supervision of the ESRD facility, the care plan provides for periodic monitoring of the patient’s home adaptation, including provisions for visits to the home by qualified facility personnel to the extent appropriate. (See § 405.2163(e).)[/I]
Section 405.2163(3) which discusses minimal service requirements of facilities states:
I Standard: Self-dialysis support services. The renal dialysis facility or center furnishing self-dialysis training upon completion of the patient’s training, furnishes (either directly, under agreement or by arrangement with another ESRD facility) the following services:
(1) Surveillance of the patient’s home adaptation, including provisions for visits to the home or the facility;
(2) Consultation for the patient with a qualified social worker and a qualified dietitian;
(3) A recordkeeping system which assures continuity of care;
(4) Installation and maintenance of equipment;
(5) Testing and appropriate treatment of the water; and
(6) Ordering of supplies on an ongoing basis.[/I]