Rehabilitation Centers and PD: Building Community Partnerships

This blog post was made by Megan R Prescott, LCSW, NSW-C on March 27, 2014.
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:

  1. 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.
  2. Interest from a community partner to develop a program and maintain it in partnership with dialysis providers.
  3. Staff training:
    1. Initial skill building
    2. Follow up to maintain skills
    3. Follow up when a patient is ready for admission to assure confidence from all parties
  4. Develop policy and procedure jointly with facility staff to satisfy all of the following:
    1. Training
    2. Support from dialysis provider
    3. Support from MD
    4. Space for supplies
    5. Ordering supplies
    6. 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.

Comments

  • Mary Patricia Moretti

    Mar 21, 2023 1:54 AM

    I am looking for a short term medical rehab in CA which accepts peritoneal dialysis patients. Any guidance would be greatly appreciated!
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    • Dori Schatell

      Apr 19, 2023 5:24 PM

      Hi Mary, I'm so sorry that we didn't see this sooner. Unfortunately, there is no national list that we are aware of that includes which rehab facilities (short- or long-term) offer PD, so we just don't have any way to find this information. I wish we did. In our experience, PD is quite rare in skilled nursing facilities (SNFs), and most people who need dialysis are sent out to get standard in-center hemo in clinics. The time this takes and the symptoms it causes can make it difficult or impossible for people to get the therapy hours they need. The other model tends to be to offer hemo IN the rehab center--but not PD. The only way we know of to see what is offered is to call every rehab center in the area. :-(
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  • Bridget Marks

    Feb 22, 2023 1:31 PM

    Good morning:

    I’m a Business development Director/Nurse Liaison for 3 inpatient rehab hospitals in Louisiana and offering inpatient rehab to PD patients is something I’m actively working on.

    As someone who had a nephew who was on hemodialysis prior to a kidney transplant, I can only imagine the stress of someone who is on PD having to go to HD to be able to receive inpatient rehab.

    I am actively working on forming a community partnership in an effort for our hospitals to be able to provide this service. I have been told by a PD home nurse that this is truly a need in our communities because people are forced to stay in the hospital or transition to short term HD to get needed rehab. Of course in the acute hospital, patients will only get about 25-30 minutes a day as opposed to 3 hours a day.

    I will not give up in this endeavor and would appreciate any help or information.

    Thank you,
    Bridget P. Marks
    225-270-3941
    Bmarks@umrhospital.com
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  • Cheryl Johnston

    Jan 08, 2023 3:23 PM

    I am reaching out from my friend who needs PD dialysis in a rehab center while recovering from surgery and possibly someone for PD dialysis in the home help
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  • Veronica Maury

    Jun 20, 2022 4:39 PM

    Hi, we are in need of a rehab facility for my father within the next that will accept him as a PD patient between Long Valley NJ and Sayer PA. Any info would be greatly appreciated!
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  • Trisha Vargas Battaglia

    Mar 05, 2022 8:05 PM

    I am in San Diego and looking for a physical rehab place for my brother in-law that is recovering from hip surgery, he needs long term pt.
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  • Brian Z.

    Oct 28, 2021 6:33 PM

    Hi, I'm a case manager for a hospital in LA. Would like to ask your help.. I'm looking for a Skilled nursing facility in Los Angeles or Orange county that has Peritoneal Dialysis services. if you can email me the list would really appreciate it. thank you so much
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    • Dave

      Jul 14, 2022 8:51 PM

      We're in the same boat. Can u tell us if you found one
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    • Karen

      Mar 25, 2022 8:03 PM

      I'm looking for assistant Living or Rehabilatation hospital that offer PD for my Mom. Please send a list if you have ...
      Thank you
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    • Lynda

      Dec 16, 2021 12:55 PM

      Did someone send you a list for Los Ángeles? I need the same list for myself - thank you!
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  • JoAnna Gomez

    Oct 09, 2021 9:53 PM

    Hello,
    I’m looking for a place for my mom, she fractured her chest bone & my brothers & I have to go to the rehab place she’s at to hook her machine up every night, we are looking for a place in Phoenix Az that does the peritoneal dialysis. Any help would be appreciated!
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  • Phil Bruce Harting

    Jul 01, 2021 4:05 AM

    Hello....im looking for a inpatient drug rehabilitation center for a dialysis patient. Her life depends on getting help as quickly as possible. Would you be able to lead me to a place that might accept her in?
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  • Joe leone

    Jun 06, 2021 4:25 PM

    What rehab facilities near emporia Kansas help patients on PD dialysis?
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  • Tracy Montgomery

    Mar 16, 2021 4:28 PM

    I am looking for a rehab center for my dad that does physical therapy for patients on peritoneal dialysis in Jackson , Vicksburge or the surrounding areas in Mississippi
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  • Gail Evans

    Mar 19, 2019 12:36 PM

    My mother is currently in Northside Hospital Cherokee. She needs a rehab facility, for her knee, that does PD. We have been searching and can only find facilities that offer HD, which my mother refuses. Can you tell me if there are any facilities between Atlanta and Blue Ridge that can help her?

    Thank you in advance!!!
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    • Rhonda Browning

      Sep 03, 2021 3:43 PM

      My father recently had both legs amputated. He is on Peritoneal Dialysis. We are looking for a rehab facility to help him learn to move from Bed to Wheelchair - Wheelchair to Chair - Wheelchair to Bed, Etc. Anyone know of any facilities in the Southeast? We are in Georgia, but are willing to transport him where ever he can be served, since COVID is limiting our ability to visit him regardless of where he is.
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    • Beth Witten

      Mar 19, 2019 2:57 PM

      When I worked in dialysis years ago, there were a number of skilled nursing facilities (SNF) that offered rehabilitation that also had staff who were trained to do peritoneal dialysis. Patients who do PD in a SNF must be admitted to a dialysis facility that coordinates and oversees their kidney care with the SNF. One way to find SNFs that offer PD in a SNF is to call your state survey agency and ask to speak to an ESRD surveyor. Every dialysis facilities is required to complete a form (CMS 3427) that tells the state whether they have patients receiving PD in a SNF/nursing facility. You can find the phone number of the ESRD state survey agency on the Medicare website. Choose your state and under Organization select ESRD state survey agency. https://www.medicare.gov/contacts/
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  • Bonita Collins

    May 19, 2017 1:59 PM

    I am searching for rehab centers in the Maryland/DC/Virginia area who provide services for peritoneal dialysis patients.
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    • Trish Pollak

      Dec 30, 2020 11:48 PM

      My father is in a short term rehab center in MD that does not accommodate his PD dialysis, were you able to find a rehab center that to accommodate your needs?
      Thanks
      Trish
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