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The Case for Providing Dialysis in Nursing Homes

By: Brian Wallace


Senior husband visiting his disabled wife on the grounds of the nursing home while a nurse pushes her wheelchair.

Kidney failure is a covert crisis in the United States.  In 2018, 786,000 Americans were living with end-stage renal disease (ESRD for short), costing $49 billion in Medicare spending.  The majority of that money went to providing dialysis to patients.  While a functioning kidney transplant is the ideal cure for ESRD, only 30% of patients are lucky enough to receive one.  The rest must receive regular treatment, which is provided an overwhelming majority of the time at outpatient clinics.

For too long, the main providers of dialysis treatment have prioritized the needs of their active, middle aged patients.  In truth, 80% of ESRD patients are 65 or older.  Many of them live in nursing homes.  Outpatient dialysis clinics are not designed with nursing home residents in mind. 

These clinics pose an increased infection risk to dialysis patients, nursing home staff, and other nursing home residents, especially when contagious diseases like coronavirus are running rampant.  Traveling to a dialysis clinic is disruptive, confusing, and time consuming for elderly patients with limited transportation options.  Some highly acute patients even struggle to find placement at local outpatient clinics.

To better serve their residents, nursing homes should provide on-site dialysis.  This would eliminate outpatient drawbacks, eliminating hours of travel time and infection paranoia for a resident.  When the resident doesn’t have to waste time traveling to a dialysis clinic, they have more time for therapies and social activity, thereby improving their quality of life.  On the nursing home operators’ end, the provision of on-site dialysis opens up the opportunity for their facility to admit higher acuity patients than before.  They can also save up to $411 per trip in transportation costs.  Better care at a lower cost spells victory for everyone.

In choosing the type of dialysis to provide, nursing homes should favor 3-day dialysis over its daily counterpart.  98% of nursing home residents who need dialysis are already accustomed to 3-day dialysis at outpatient clinics.  Switching them over to daily would require prescription changes, which can cause confusion or disruption in care.  3-day dialysis requires 17% less treatment time than daily dialysis, again saving residents’ time. 

Most importantly, daily dialysis carries greater risk of missed treatments, hospitalizations, or surgery.  Complications like blood clots and aneurysms increase with daily dialysis.  For operators, 3-day dialysis allows the facility to treat more patients with the same initial investment, making it a win on all sides.

Dialysis in Nursing Homes

Published: August 20, 2021

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Brian Wallace

Brian Wallace is the Founder and President of NowSourcing, an industry leading infographic design agency based in Louisville, KY and Cincinnati, OH which works with companies that range from startups to Fortune 500s. Brian also runs #LinkedInLocal events nationwide, hosts the Next Action Podcast, and has been named a Google Small Business Advisor for 2016-2018.

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