Rehabilitation Centers and PD: Building Community Partnerships
Almost immediately after accepting a part-time position in a home dialysis program at the University of Colorado Hospital (where I have worked for more than 6 years), I discovered a service gap in the community that was affecting the care of our patients. There was a surprising absence of skilled nursing facilities that could support the peritoneal dialysis (PD) patient during a short-term rehab stay. Without these community partnerships, patients on PD who need rehabilitation after a hospitalization were either forced to stay in the hospital longer than was necessary for physical therapy or forced to switch to hemodialysis (HD) for a period of time to facilitate rehab placement.
I reached out to people in my local community, where I learned about what makes this so difficult – and why local programs that once existed had failed. Facilities with trained staff lose their knowledge and skills when there are long periods of time between PD patient admissions, or through staff attrition. Facilities build exclusive partnerships with programs owned by a particular company, further reducing the pool of available patients to maintain staff skills and facility interest. Through contact with the national community of nephrology social workers, brought together by an email listserv, I was able to gather encouragement from programs that were able to stay successful with rehabilitation facility partnerships. Literature was remote and scarce, but helped craft a complete program proposal.
With an outline of what a successful partnership should look like, we set out to find rehab facilities that were interested in learning how to support PD patients. We looked for nursing facilities with minimal staff turnover. We also focused on facilities that we knew were successful and supportive of HD patients and might have a foundation of knowledge around caring for patients with ESRD. Ultimately, it wasn't as challenging as I feared it might be to find nursing facilities who were interested in learning about PD and supporting this group of patients.
This was our outline for meetings with interested skilled nursing facility administration and staff:
- Market Research: Lack of skilled nursing facilities in the area that can support the peritoneal dialysis patient in need of a short term (or long term) rehabilitation stay.
- Interest from a community partner to develop a program and maintain it in partnership with dialysis providers.
- Initial skill building
- Follow up to maintain skills
- Follow up when a patient is ready for admission to assure confidence from all parties
Develop policy and procedure jointly with facility staff to satisfy all of the following:
- Support from dialysis provider
- Support from MD
- Space for supplies
- Ordering supplies
- Ongoing training to support excellence in caring for the dialysis patient
We discussed our proposed model for providing training rehab facility staff, and providing follow up and refreshers when we had a PD patient ready for rehab.
This proposal was intended to support PD patients in need of short-term rehabilitation with the goal of discharge back to home in a short time frame (weeks, ideally). A key element involved the availability of our program RN's to support the rehab facility staff as needed, similar to the on-call support they provide to patients. This is not an exclusive partnership, but when patients are admitted from other PD programs, the expectation is that the patient's PD program would provide RN support.
Other considerations included storage space for supplies, private rooms, and the availability of a family member or support person to bring the patient's PD cycler and available supplies to the SNF at the time of transfer.
Within four months, we were able to establish partnerships with two skilled nursing facilities and train groups of interested staff at each. Our PD program nurses are available to ensure staff is ready to care for patients as rehabilitation needs arise.
Ultimately, I hope this experience is helpful to others who may be facing a similar service gap.