In 2018, 786,000 Americans were living with end-stage renal disease (ESRD).  Kidney failure is a crisis that disproportionately affects older Americans.  80% of patients with ESRD are over 65 years old.  Medicare spends $49 billion on ESRD care, with the majority of the money funding dialysis treatments. While kidney transplants are the cost effective, permanent solution to ESRD, only 30% of ESRD patients have functioning kidney transplants.  The rest rely on dialysis to perform the filtering function their kidneys can no longer do.  At present, 86% of dialysis treatment occurs at outpatient clinics.  A patient must travel to said clinic multiple times a week for treatment.  This system is not good for older Americans, specifically nursing home residents, because many struggle with transportation and placement at these clinics.  If nursing homes were to offer dialysis on-site for their residents, they could eliminate transportation costs while admitting higher acuity patients. In choosing the type of dialysis treatment to offer, 3-day treatment, not daily.  98% of nursing home dialysis patients are already accustomed to 3-day outpatient dialysis.  Switching would require prescription changes and could disrupt continuity of care.  Daily dialysis also carries greater risk of hospitalization or surgery.  Such difficulties include struggling with the blood-access site, blood clots, and aneurysms. nursing homes should offer Care should be the primary reason for selecting a treatment option.  Yet nursing homes are also worried about costs, and that should be acknowledged.  The truth is that 3-day dialysis is also more cost effective for nursing homes than daily dialysis would be.  For the same initial investment, on-site, 3-day dialysis provides treatment to 3 times as many patients as daily dialysis would.  With 6 chairs installed, 3-day dialysis can support up to 36 patients.  Compare that with daily dialysis, in which six chairs can support only 12 patients at any given time. Large dialysis providers have failed to deliver effective and flexible treatment for nursing home patients. Need exists for a different model.  Nursing homes need in-house dialysis care designed for geriatric patients.  Nurses saw the need and are working to provide care nationwide.

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