Enhancing Dialysis Care in Long-Term Care Facilities: A Focus on Certification Standards

By Teresa Hoosier, RN, CDN

The integration of dialysis services within long-term care (LTC) facilities presents unique challenges and opportunities for improving patient outcomes. With the introduction of the Long-Term Care Dialysis (LTCD) Certification, the Accreditation Commission for Health Care (ACHC) aims to elevate the standards of care for this vulnerable population. This article explores the critical components of the LTCD Certification, its impact on patient outcomes, operational efficiency, and the importance of collaboration between providers.

Integration of standards and impact on patient outcomes

The LTCD Certification incorporates all existing CMS Conditions for Coverage (CFC) for End-Stage Renal Disease (ESRD) Home Dialysis, supplemented by ACHC standards that emphasize coordination between dialysis providers and LTC or skilled nursing facilities (SNF). This approach ensures continuity of care through enhanced education, communication and collaboration, addressing the unique needs of patients in these settings. By fostering strong partnerships and clear communication channels, the certification helps manage complex care requirements more effectively. Additionally, it includes ongoing staff training and education to ensure all team members are equipped with the necessary skills and knowledge to deliver high-quality, patient-centered care.

The certification focuses on improving clinical outcomes related to nutrition, anemia management, dialysis dose adequacy (Kt/V) and vascular access type. Continuous improvement is driven by an active Quality Assessment and Performance Improvement (QAPI) Program, which involves monthly data monitoring and collaborative meetings to review and implement strategies for improvement. This interdisciplinary approach is crucial for achieving optimal patient outcomes.

Enhancing efficiency, infection control, and training in long-term care dialysis

Efficient operational practices are a cornerstone of the LTCD Certification, aiming to reduce hospitalizations and readmissions, enhance patient safety and promote a better overall patient experience. The certification emphasizes fall risk assessments, tailored patient care planning, appropriate staff-to-patient ratios and aligning care requirements with patient acuity levels.

Infection control is another critical component. The standards mandate stringent infection control measures akin to those used in in-center dialysis settings. This is particularly challenging in LTC/SNF environments, where staff may have varying levels of knowledge about dialysis-specific vulnerabilities. The certification requires comprehensive training for both dialysis and LTC/SNF staff to ensure they can provide safe, high-quality care tailored to each patient’s needs.

Effective coordination of care hinges on proper education and training for both dialysis and LTC/SNF staff. The certification includes written education modules covering topics such as access care, post-treatment complication management, dietary education, infection monitoring and managing higher acuity conditions like respiratory compromise in relation to tracheostomy. This training enhances staff awareness of the specific risks faced by dialysis patients, improving the likelihood of safe, quality care.

CMS guidance and benefits, and collaboration between providers

The revised CMS guidance has significantly influenced the development of the LTCD Certification. The certification addresses gaps in home dialysis standards for LTC/SNF settings, offering an elevated model of care. For patients, the primary benefit is the ability to receive dialysis within their place of residence, avoiding the stress and hardship of frequent transfers to in-center facilities. This improvement in care delivery is particularly beneficial for patients with complex clinical needs.

Successful patient outcomes also depend on effective collaboration between dialysis providers and LTC/SNF staff. The LTCD Certification mandates documented evidence of hand-off procedures and communication protocols that ensure continuity of care. Key elements of this collaboration include sharing treatment orders, medication records, patient assessments, vaccination records and detailed health status updates.

Steps for certification

To initiate the certification process, ESRD providers must ensure compliance with current CMS CfC for ESRD and prepare for a successful survey through self-assessment against the LTCD standards. Hospitals with ESRD outpatient programs can also pursue this certification. Accreditation leaders need to prepare by gathering essential documentation, including compliance evidence and operational policies aligned with the LTCD standards.

ACHC offers extensive support and resources to organizations seeking certification. This includes access to the LTCD Certification standards, checklists and other preparatory documents. The application process is straightforward and begins through ACHC’s Customer Central portal. ACHC also provides newsletters, webinars and direct assistance from the customer care team to ensure a smooth and successful certification process.

The LTCD Certification represents a significant advancement in the quality of dialysis care provided in long-term care settings. By integrating comprehensive standards, emphasizing collaboration and ensuring continuous improvement, ACHC is committed to enhancing patient outcomes and operational efficiency. Through this certification, dialysis providers and LTC/SNF staff can work together to deliver optimal care to one of the most vulnerable patient populations.

Teresa Hoosier, RN, CDN, is Associate Clinical Director, Accreditation Commission for Health Care (ACHC).