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Optimizing Dialysis in Nursing Homes: Navigating Compliance and Care Standards for F698

Optimizing Dialysis in Nursing Homes: Navigating Compliance and Care Standards for F698

Posted on January 14th, 2024

Nursing home residents facing the need for dialysis treatments encounter two primary options: receiving care at a dialysis facility or within the nursing home itself. This decision hinges on various factors, such as transportation and the nursing home's capacity to offer hemodialysis (HD) or peritoneal dialysis (PD) services. In this article, we delve into the regulatory requirements surrounding dialysis services in nursing homes, highlighting the responsibilities of facilities and dialysis providers.

Before we get started, let's review the requirements for F-968: CMS states.

§483.25(l) Dialysis.

The facility must ensure that residents who require dialysis receive such services that are consistent with professional standards of practice, the comprehensive person-centered care plan, and the resident's goals and preferences.

INTENT: §483.25(l)

The intent of this requirement is that the facility assures that each resident receives care and services for the provision of hemodialysis and/or peritoneal dialysis consistent with professional standards of practice.

Ensuring Compliance With - F698 Dialysis:

While there isn't a regulatory mandate obligating nursing facilities to provide dialysis services, they are accountable for ensuring residents in need of dialysis receive appropriate care. Upon admission, the nursing home commits to meeting the resident's needs through its staff and resources. The key requirements under the Dialysis regulation include:

  1. Ensuring residents receive hemodialysis and/or peritoneal dialysis in line with professional standards.
  2. Maintaining the same quality of care for dialysis recipients as for non-dialysis residents.
  3. Assisting residents identified as meeting dialysis criteria in transferring to a suitable setting if onsite services are unavailable.

Regulatory Compliance Details:

The regulatory framework, outlined in Appendix PP of the SOM, mandates ongoing assessments, monitoring, and collaboration to maintain professional standards of practice. Key aspects include:

  • Nurses must conduct assessments and monitor for complications before and after dialysis treatments.
  • Facilitating communication with dialysis facilities regarding the resident's care.
  • Safely administering dialysis services by qualified, trained staff.
  • Ongoing assessment and oversight of residents throughout the dialysis process, including infection control techniques.

Responsibilities Clarified:

Distinct responsibilities lie with the nursing home, dialysis facility, and dialysis provider:

  1. The Nursing Home Must:
  • Ensuring overall quality of care, including assessments, care planning, and care provision.
  • Collaborating with the dialysis facility to create and implement a coordinated plan for dialysis treatments.

2. Dialysis Facility Should:

  • Managing medical aspects of ESRD, including both onsite and offsite dialysis treatments.
  • Providing necessary equipment, supplies, maintenance, repair, and training for HHD/PD.

Key Survey Tips:

Here are some tips from SMK Medical to help you avoid receiving a citation:

  1. Ensure contracts are in place for each dialysis facility used by each nursing home resident.
  2. Pay attention to the need for contracts related to transportation to and from offsite facilities.
  3. Pre and post-resident assessments must be completed and logged in the patient's chart, not a folder.
  4. Ensure care plans are updated and reviewed PRN. The IDT team should review each care plan per the facility policies and with each MDS. When examining the care plans, compare what the care plan says to reality.
  5. Ensure the Kardex is updated for clinical staff, including the certified nursing assistants. Should the resident be weighed each day?


Nursing homes can ensure compliance and provide high-quality care to residents needing dialysis treatments by understanding the regulations and responsibilities surrounding dialysis residents. Diligence in establishing contracts and coordination between nursing homes and dialysis facilities is essential for a seamless and compliant dialysis program.

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