Dialysis in Nursing Homes and Residential Care Facilities Triumphs and Challenges 1
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Dialysis in Nursing Homes and Residential Care
Facilities
Triumphs and Challenges 1
Speakers ´ Susan Markovich MBA, RN, CNN
VP Clinical Operations Affiliated Dialysis Centers Glen Ellyn, IL ´ Nola McMullen, RN Chief Operations Officer
Reliant Renal Care, Inc. Media, PA
´ Glenda Payne, MS, RN, CNN Director of Clinical Services Nephrology Clinical Solutions
Lisle, IL
2
Disclosures
´ Ms. Markovich and Ms. McMullen work for companies that provide dialysis in nursing homes
´ Ms. Payne works for a consulting company that has provided guidance to companies that wish to provide dialysis in nursing homes
3
Objectives:
• Identify current regulatory requirements applicable to providing dialysis in long term care (LTC) facilities
• Describe challenges of providing dialysis in LTC
facilities • Detail effective options to meet the challenges of
providing dialysis in LTC facilities • Discuss outcomes of patients receiving dialysis in LTC
facilities
4
To Be Clear:
´ This session is about dialysis IN nursing homes ´ Not about dialyzing nursing home patients
in an outpatient center. ´ Acronyms used interchangeably here:
´ LTC: Long term care ´ NH: Nursing home ´ SNF: Skilled nursing facility
5
Applicable Regulations
´ Reimbursement regulations
´ The current ESRD quality & safety regulations are silent on dialysis in nursing homes
´ However, there is some guidance from CMS…
´ Vary greatly from state to state
´ From no regulations
´ To very specific
Federal
State
6
Federal Guidance for Dialysis IN Nursing Homes
Official: Survey & Certification Letters, 2004
´ Based on “old” ESRD regulations
´ Currently being updated
´ Potential release date of update: Unknown
7
Survey & Certification Guidance, 2004
´ Separate guidance for: ´ ESRD surveyors ´ LTC surveyors
´ Major points: ´ ESRD surveyor expected to visit one or more LTC ´ Contract required between LTC /ESRD
´ Collaboration is expected ´ Infection control practices ´ Machine storage ´ Water treatment ´ Emergency equipment & response
8
Survey & Certification Guidance, 2004
Staffing requirements ´ A qualified ESRD nurse is responsible for training
patients/caregivers & LTC staff ´ An appropriately trained caregiver provides
monitoring of the patient during dialysis ´ A licensed health professional “experienced in
rendering ESRD care” is on duty to oversee dialysis ´ Perform assessments, observe patients pre/post
tx, respond to ER situations, administer injectable meds
´ Full IDT provides care
9
Survey & Certification Guidance, 2004 ´ Patient Care Plans:
´ Individualized
´ ESRD IDT team responsible to develop plan and communicate with LTC to address patient needs
´ Coordinated with LTC care plan
´ Patient Rights & Responsibilities:
´ Patient/family informed of options
´ Aware of grievance/complaint procedures
10
Survey & Certification Guidance, 2004
QAPI
´ Patient outcomes are monitored
´ Identified problems are addressed
´ Incidents and accidents involving dialysis care in the LTC are reported to both the LTC and the ESRD
11
What Might New Guidance Include?
Draft Letter “released” in 2012
´ A qualified RN, LPN, or Certified PCT must be “present in the room” during dialysis
´ No more than 2 patients in a room where dialysis is done
´ At least quarterly reassessment/plan of care
´ MSW/RD communicate monthly with LTC staff/patient
´ Care coordinator for each LTC dialysis patient
´ Weekly audits of treatment records
12
What Might New Guidance Include?
Draft Letter “released” in 2012:
´ Monthly face-to-face contact medical staff/patient
´ Monthly home visits
´ Quarterly competency checks for caregiver
´ A qualified RN on site & available to respond throughout the treatment
´ QAPI: compare aggregate outcomes of LTC patients with aggregate outcomes of in-center patients
13
What About State Regulations?
Important to consider all potentially applicable regulations:
´ Nurse Practice Acts (NPA) (all 50 states have these)
´ ESRD licensing regulations (~ 30 states have these)
´ Home health (HH) licensing regulations (multiple states have these)
14
A Couple of Examples
´ NPA: Only RN can assess ´ ESRD licensing
´ HH licensing
´ Required to provide care in home
´ Specific rules for HH with “dialysis designation”
´ Only licensed nurses can provide dialysis
´ NPA: specific language addresses home HD
´ Allows non-professionals to give injectable meds as part of home dialysis
´ ESRD licensing: No
´ HH licensing: No
Texas Florida
15
Why Do Dialysis in Skilled Nursing Facilities?
16
How Is Hemodialysis Done in Nursing Homes?
17
What Are the Challenges in Providing Dialysis in LTC?
18
What About Patient Outcomes?
19
Conclusion
´ Dialysis in SNF is a much needed service
´ Improved quality of life and outcomes
´ Daily therapy the best option
´ Challenging environment to operate in
´ Frequent survey activity
S
20
Questions?
21
References ´ Canaud,B., et al. (2011). Clinical practices and outcomes in elderly
hemodialysis patients: results from the dialysis outcomes and practice patterns study (DOPPS). Clin J Am Soc Nephrol 6: 1651–1662, 2011. doi: 10.2215/CJN.03530410
´ CMS Survey & Certification Letter (2004) retrieved from https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/SCLetter04-24.pdf
´ United States Renal Data System. 2015 USRDS annual data report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2015.
´ Weinhandl, E., Liu, J., Gilbertson, D., Arneson, T,. & Collins, A. (2012) Survival in daily home hemodialysis and matched thrice-weekly in-center hemodialysis patients. JASN. Feb 23, 2012. doi: 10.1681 ASN.2011080761
´ Yang, et al. (2014). Survival Comparison of daily home dialysis vs. conventional in the nursing home setting. NNI. 2-2014
22
Related Documents
