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Exploring Hospital Transfers for Long-Stay Nursing Home Residents With End-Stage Renal Disease
Kelli E Canada1, Amy A Vogelsmeier, Lori L Popejoy
1Author Affiliations: School of Social Work, University of Missouri, Columbia (Dr Canada); Sinclair School of Nursing, University of Missouri, Columbia (Drs Vogelsmeier, Popejoy, Powell, and Rantz); and University of Missouri Center for Health Ethics, Columbia (Dr Brandt).
Background:
Nursing home residents with end-stage renal disease (ESRD) are an understudied, yet growing population within nursing homes.
Purpose:
To describe hospital transfers for nursing home residents diagnosed with ESRD and receiving hemodialysis.
Methods:
Data were analyzed for residents with ESRD transferred to the hospital between October 2016 and September 2020 (n = 219). Descriptive statistics, bivariate analyses, logistic regression, and content analysis were used for analysis.
Results:
Clinical factors associated with transfers included abnormal vitals, altered mental state, and pain. Other factors included lack of care planning and advance directives, provider communication, resident/family preferences, missing/refusing dialysis, and facility resources. The odds of an observation/emergency department only visit was 2.02 times larger when transferred from the dialysis clinic.
Conclusions:
Advance care planning and coordinated care between nursing home and dialysis clinics are needed along with proactive planning when residents miss dialysis or experience a condition change at the dialysis clinic.
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