Abstract: SA-PO469
A Single-Centre Experience with Assisted Home Hemodialysis in Long-Term Care Facilities: A Cost-Feasibility Study
Session Information
- Home Dialysis - 2
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Nesrallah, Gihad, Humber River Health, Toronto, Ontario, Canada
- Wang, Jessica, Humber River Health, Toronto, Ontario, Canada
- Silva, Monica, Humber River Health, Toronto, Ontario, Canada
- Ashley, Justin Marc, Humber River Health, Toronto, Ontario, Canada
- Hamidi, Shabnam, Humber River Health, Toronto, Ontario, Canada
- Lam, Danica, Humber River Health, Toronto, Ontario, Canada
- Mendelssohn, David C., Humber River Health, Toronto, Ontario, Canada
Background
For hemodialysis (HD) recipients residing in long-term care (LTC), the COVID-19 pandemic created several barriers to care. To address these challenges, we established a pilot program of fully-assisted HD provided on-site to LTC residents (LTC-HD) by registered nurses (RNs), registered practical nurses (RPNs) and personal support workers (PSWs).
Methods
We performed a cost-feasibility analysis from the provider perspective using a bottom-up micro-costing approach based on real costs incurred between March 2020-March 2023. We examined a range of staffing models (in-sourced vs. out-sourced/agency and 1:1 vs higher patient:staff ratios) for providing daily (6/week, 2hrs) and conventional (3/week, 4hrs) HD. Direct costs included labor, medical supplies, and dialysis consumables using standard (Fresenius 4008K) and portable (NxStage) equipment. Indirect costs included equipment maintenance, injectables, travel, and staff replacement costs. We excluded capital, patient-borne, non-dialysis costs, and physician fees. Costs are reported in CAD/year using FY2022/23 prices.
Results
During follow-up, 44 patients received LTH-HD at 15 facilities. Bundled rates were $50,076 and $83,467 for conventional and daily HD, respectively. Conventional HD with PSWs (1:1) yielded a net loss of $2,947 vs. net surplus of $3,076 with out- vs. in-sourcing, respectively. Staffing with in- and out-sourced RNs and RPNs yielded net losses with 1:1 staffing but generated surpluses of $17,426 and $20,546 when insourced RPNs and RNs treated provided 2:1 and 3:1 clustered HD. Daily HD with NxStage cost $13,681/yr more vs. standard equipment resulting in net losses in all scenarios. Daily HD yielded a surplus when staffed by in-sourced staff with further savings under clustered models.
Conclusion
Fully-assisted LTC-HD is financially feasible under current bundled rates in Ontario, with greater savings in clustered settings with in-sourced staff.