Looking for ideas

Honestly, if as you say, they 'just don't seem to care' there is nothing you can say or do that is going to make them care.

Dial back the lecturing and contests etc and focus on working with them on what their goals are - treat then as autonomous adults - its fully within their rights to feel *hitty but also acknowledge the fact that dialysis sucks - the treatment itself makes many people feel like crap. On an individual basis investigate why the patients are cutting: Do their pressures always drop when they stay, are they itchy, does their back hurt from the chair or do they simply want to go home? Some of these issues can be dealt with.

If the barriers to care have truly been addressed there is little else you can do to make them come. Patients absolutely have the right to make their own health decisions and if that means not showing up or cutting that is their right.

On our unit, the first time you cut you have to sign a form stating you understand the risks. After that we don't harp on it. It goes much further to develop a positive (non-paternalistic) relationship than lecturing/nagging.

Honestly, we would rather people feel able to call us to cancel if they plan on not showing up, and that they show up at all even if they plan to cut. In order for that to happen they have to feel 'safe' to do so.

Look at the stages of change - very applicable here.

The only reason it's an issue at this time is that our company corporate office says we have to "make" them come. Short of going to their homes and kidnapping them, there's not much we can do. Of course the higher ups don't want to hear that. We're just trying to exhaust every avenue to allow head honchos to see that this is free will on the part of our patients. And it's a select few that choose not to show up. And over the years, (yes, most of these folks have been coming for 3+ years) there is documentation to show that these patients do understand the risks.

Good Lord... that's just ridiculous...

So.. ummm. good luck with that? :-/

Do they wind up in the hospital frequently for hyper K, overload or anemic needing transfusion? I have a few patients that have expressed they'd rather come to the hospital and get admitted because (they feel)they get they get "better treatment" because they can have family visit, get lovely IV pain meds, and they are in a room with only one other person. (I do acutes)

I would present these "higher ups" with the details of the methods you mentioned, as well as the fact that you came to a forum looking for ideas, that unless they can come up with ways to "make" adults conform to corporate goals they can kindly stop harassing your overworked butts. Makes me angry when some dimwit sits in a meeting and comes up with so called solutions that are not solutions at all. Whew - Rant over.

Do they wind up in the hospital frequently for hyper K, overload or anemic needing transfusion? I have a few patients that have expressed they'd rather come to the hospital and get admitted because (they feel)they get they get "better treatment" because they can have family visit, get lovely IV pain meds, and they are in a room with only one other person. (I do acutes)

Overall, not as much as you'd think. It's odd. I think it's an attitude in my geographic location