Why Dialysis Needs to Improve in Nursing Homes

Kidney failure is a crisis undercover in the United States.  In 2018, nearly 800,000 Americans were living with end stage renal disease (ESRD for short).  While the most fortunate patients are able to be cured by a functioning kidney transplant, most ESRD patients rely on an expensive, life-saving treatment called dialysis to survive.  Dialysis makes up the bulk of Medicare spending in this area; in 2018, Medicare spent $49 billion on ESRD patients.


Dialysis takes place at outpatient clinics 86% of the time.  This arrangement may work for active, middle-aged dialysis patients, but the majority of people in need of dialysis don’t fit that profile.  In fact, 80% of ESRD patients are 65 or older, and many of them are nursing home residents.  


Outpatient dialysis care is difficult on nursing home residents for several reasons.  The first reason is prominent due to the coronavirus pandemic; outpatient treatment poses an infection risk for vulnerable populations.  When a resident is exposed to a contagious disease at an outpatient clinic, they have the potential to expose other residents and nursing home staff to the disease as well.  Furthermore, nursing home residents are often limited in their transportation options.  Traveling to a dialysis clinic is disruptive and time consuming for them.  Finally, some highly acute residents struggle to find placement at outpatient clinics due to their unique needs.


Were nursing homes to offer on-site dialysis, both patients and caregivers would benefit.  The resident can eliminate hours of travel time per week, opening up more time for therapies and social activities that improve their quality of life.  They also face decreased risk of infectious diseases.  For the nursing home operators, facilities with on-site dialysis can accept higher acuity patients than those without.  While installing dialysis equipment in house is an investment, operators eliminate up to $411 per trip in transportation costs by doing so.  The best solutions are the ones in which every party comes out ahead.


When choosing the type of on-site dialysis to offer, nursing homes should favor 3-day treatment over daily.  98% of nursing home residents who need dialysis already receive 3-day treatments from outpatient clinics.  Switching their prescription would cause confusion and may disrupt continuity of care.  Additionally, daily dialysis generates more risk of missed treatments, hospitalization, or surgery.  Some complications that are more likely with daily dialysis are blood clots, aneurysms, and difficulty with the blood access site.  All these issues are easily avoided by offering 3-day dialysis instead of daily.  On the operators’ side, 3-day dialysis is also more cost effective.  For an identical upfront investment, on-site, 3-day dialysis provides treatment to 3x more patients than daily would.  6 dialysis chairs installed would support 36 patients on 3-day dialysis, but only 12 on daily dialysis.


Nursing homes need in-house dialysis care designed specially for their residents.  Large dialysis providers have done a poor job accommodating their needs.  Nursing home collaborations with a skilled nurse facility team would allow continuous, customized care for the silent majority: elderly ESRD patients.

Creating the Factory of the Future

In 2018, just 12% of companies had a mature factory of the future plan.  And it showed.  When the COVID-19 pandemic hit, manufacturing suffered a wide variety of disruptions.  Supply chains got shuttered, delays interrupted production across the board, increasing costs have driven widespread inflation, and an atmosphere of anxiety about the future permeates every meeting room.  Despite the chaotic world surrounding them, manufacturers are under constant pressure to fill orders quickly, optimize quality and efficiency simultaneously, and improve working standards while reducing costs and increasing production complexity.  The current model is insufficient for meeting all these needs given the world manufacturers live in today.

What does the factory of the future look like?  Such an invention will need adaptable technology and equipment, items that can be easily moved and reconfigured to accommodate new products and changes.  AI-powered product demand simulations will assist businesses in determining how to scale production to optimize efficiency and agility together.  With new technology comes new workforce demands; a versatile workforce is required to interpret data and work in virtualized or augmented reality environments.  Industrial Internet of Things (IIoT) can connect devices and processes in a massive data sharing network.  Sensors can track the manufacturing process, identify potential improvements, and watch for faulty equipment in real time.  Cloud software can foster connections across physical and organizational barriers, simplifying live team interactions and complex data at the same time. 

Equally important to improving the manufacturing process is improving its sustainability.   Manufacturing alone represents 20% of global emissions; major changes to the sector would have a dramatic impact on the global trajectory towards warming.  If just 5 areas of manufacturing improved, emissions would fall by an amount equal to the elimination of all transportation.  From a business perspective, responsible waste management reduces the cost of doing business.  Efforts to increase sustainability drive innovation while bolstering the company’s public image.  Green processes can also ensure regulatory requirements are met preemptively; most businesses would prefer to set their own schedule instead of letting a government impose one on them. 

Outside the factory doors, a factory of the future will require a new type of supply chain.  As the COVID-19 pandemic revealed, issues on one side of the supply chain have a rapid ripple effect across the global economy.  To avoid similar issues from arising in the future, companies should switch from single source suppliers to creating a value network.  While single suppliers are available at a lower cost, value networks are more resilient and have more flexibility built into them.  Future factories can also leverage advanced planning and scheduling (APS) to plan for potential disruptions and ensure their network is able to bounce back from challenges.

The future is now.  Starting your transformation journey is long overdue.  Here’s how to do it: look for disruption opportunities, determine your company’s maturity, plan and execute your strategy, and drive transformation success.  Success relies on the integration of people, process, and technology.  The neglect of one can cause all three to fail.