Addressing the special needs of residents with ESRD


About 14 percent of the general population has chronic kidney disease (CKD), according to the National Institutes of Health. People with this condition have kidneys that are damaged and cannot filter blood as well as possible. This damage can cause wastes to build up in the body and lead to other health problems, including cardiovascular disease, anemia and bone disease. People with early CKD tend not to feel any symptoms until the disease is very advanced. The only ways to detect CKD are through a blood test to estimate kidney function and a urine test to assess kidney damage. Major risk factors for kidney disease include diabetes, high blood pressure and a family history of kidney failure. CKD is usually an irreversible and progressive disease and can lead to kidney failure over time if it is not treated.
Once detected, CKD can be treated through medication and lifestyle changes to slow down the disease progression, and prevent or delay the onset of kidney failure. However, more than 661,000 Americans have kidney failure, known as End-Stage Renal Disease or ESRD. The only treatment options for kidney failure are dialysis or a kidney transplant. Dialysis (hemodialysis and peritoneal) is a process that artificially filters wastes from the blood. Adults aged 75 years and older comprise the fastest growing segment of the population needing dialysis each year, according to a 2013 study. In long term care facilities, older residents with ESRD on dialysis are a very vulnerable population with special needs.
CMS requirements
Residents may receive dialysis either at an off-site certified ESRD facility for dialysis treatment or on-site from a home dialysis provider. In August 2018, the Centers for Medicare & Medicaid Services (CMS) released several updates to the State Operations Manual addressing how dialysis providers can deliver treatments to residents in long term care facilities. Several of these rules impacted facilities with new requirements for supervision and training. According to CMS:
“The nursing home is responsible for providing a safe environment for the dialysis treatments, monitoring the resident before, during, and after dialysis treatments for complications possibly related to dialysis, and provides all non-dialysis related care. Nursing home staff must be prepared to appropriately address and respond to dialysis related complications and provide emergency interventions, as needed.” The provider of the dialysis services must ensure that supervision of dialysis is provided by a trained registered nurse or licensed practical/vocational nurse, depending on the type of dialysis treatment. Also, nurses who supervise hemodialysis treatments in the nursing home must complete an approved training program.
CMS has also made recent changes to guidelines on funding for treatment of ESRD and people with acute kidney injury. Long term care facilities that have residents with CKD or ESRD need to stay abreast of regulatory changes and health information. The Compliance Store is a comprehensive resource designed especially for long term healthcare providers. In addition to fact sheets and publications that address kidney disease and numerous other conditions, the site has searchable information from CMS and more than a dozen other regulatory agencies. To learn more, go to