[stephanie26]

Do you have any knowledge about patients who are on hemodialysis and need acute level rehab? all facilities in my area deny patients acceptance because of transportation to dialysis units and because of time spent away from the facility. Please help.

[Jason Beck]

I have a 5 bed acute hemodialysis unit. We have an acute rehab program in our hospital and we work closely with them to provide dialysis to the patients. It is a day to day battle juggling, PT, OT, Speech and a 4 hour dialysis treatment into the persons schedule. I feel rehab at this level is very important to the patients recovery, yet we do argue with PT and the other disciplines about when dialysis should be done. If we do dialysis before PT the patient is too tired after their TX to exercise so they want us to wait until after 5:00 PM to do dialysis. It got to be so much
of a struggle to work with them that I wanted to tell them that we would just not dialyze the patient for the 10 or 15 days they were in rehab and then they could see how productive that patient could be. Thankfully it didn’t come to that. We asked to have those patients on Tues. Thurs, and Sat. for their TX’s. Rehab schedules the patients to have light days on Tues. and Thurs and not much was being done on Sat. anyway. If we have lots of patients and can accommodate running the patients in the afternoon we will so that the therapies can use the AM. You should be able to work something our with the rehab floor that could work for all.

[RNMSNFNP]

This is a major problem because of the transportation issue. The SNF or LTC facilities to not receive any reimbursement for the dialysis transportation so they do not want the hassle. A few SNF have dialysis unis included - this is ideal. Others have a contract for services so the patient does not need transportation, the nurses come to them. Schedluing around rehab servics always creates conflicts, but the patient needs all of the care being provided so every effort must be to accommodate the patient's needs