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Country Nursing Home may accept dialysis patients in the near future


February 18, 2010
OSSIPEE — Mountain View Nursing Home is planning on accommodating patients who require dialysis treatment by June, its administrator said on Monday.

Since 2005, the county nursing home hasn't accepted residents who require dialysis because officials say the facility lacks the resources to care for such patients. However, that may change, the nursing home's administrator Sandi McKenzie told lawmakers at the Carroll County Legislative Delegation meeting on Monday.

Over the next few months, the staff will become educated on dialysis related treatment issues, establish a relationship with dialysis center in Stafford County, and develop policies and procedures for providing medical oversight. McKenzie estimated the process could be completed by June 1.

After that, the home may be able to accept dialysis patients. However, their treatment would take place at a dialysis centers outside the county. One major sticking point would still be transportation.

"The hardest part of handing a dialysis patient is the closest dialysis centers to us are in Rochester and Laconia — there is a transportation issue," said McKenzie. "We'll have to look at it with eyes wide open."

This issue first came up a few weeks ago when Tamworth resident Richard Stockbridge asked why the county wouldn't admit his wife, Grace, into Mountain View just because she needs dialysis. Grace is currently living in a private nursing home and is transported by ambulance to Rochester three days per week.

Commissioner Chip Albee noted the need for dialysis service at the nursing home is still unclear. After weeks of discussion, the commissioners haven't heard from any other families that require dialysis service. Albee said he wouldn't support going too far with dialysis until there's a demonstrated need. At a previous meeting, Albee estimated it would cost an extra $60,000 to care for a dialysis patient.

"I'm going to be resistant to adding to the budget…to satisfy the needs of one individual if there is appropriate placement in an appropriate nursing home to accommodate that person," said Albee. "Do all nursing homes have to provide all services? That's the overriding question."

Albee added the county doesn't have a cardiac center either. Then he asked the delegates if the county nursing home should make a special effort to accommodate HIV positive residents as well.

But Rep. Ed Butler (D-Hart's Location) said the philosophy should be that the county would take care of its residents. However, he said the county should do an analysis of the fiscal impact of taking on dialysis patients.

Rep. Mark McConkey (R-Freedom) didn't mention the Stockbridge family by name, but said he was concerned that the nursing home rejected someone from his district. McConkey said his investigation revealed that the county officials had several reasons for rejecting dialysis patients. One was the staff wasn't trained to a level to accommodate dialysis patients. Another reason is the county requires a nursing home staffer to accompany a resident to and from dialysis treatment, said McConkey who suggested the rule could be adjusted.

McKenzie replied that the nursing home's Family Council decided that cognitively impaired residents must be accompanied when they leave the nursing home for treatments. Also, ambulance services may not cover all residents who need dialysis, she said.

Commissioner Dorothy Solomon added a doctor must prescribe ambulance service as a medical necessity before Medicare will cover the cost.

Further, McConkey said county officials had maintained that no other county nursing homes are admitting dialysis patients. However, Ossipee officials have told him that Grafton County Nursing Home has admitted a dialysis patient.

But Commission Chair David Sorensen said an official from Grafton County told him that Grafton County's nursing home no longer admits patients who require off site dialysis — however they did accept such patients three to five years ago.

McKenzie added a few other county nursing homes in the state do accept dialysis patients, but those nursing homes are much closer to a dialysis center or hospital that can provide the service.

"Because Carroll County doesn't have any dialysis centers our residents are going hither and yawn," said Solomon. "I know people are going to Lancaster, Maine, Rochester, Laconia and God knows where else."

Rep. Karen Umberger said she heard there was a dialysis technique that allows patients to do the procedure themselves. She wondered if the county could provide that service.

McKenzie replied the procedure is called peritoneal dialysis. It requires more space than the current facility allows. It could be done in a bathroom, but at the current facility four people share a bathroom. Mountain View staff may be able to provide the peritoneal dialysis at the county's new nursing home, which will be completed sometime in 2011.

Last week, Scott McKinnon, the new CEO of Memorial Hospital in Conway, said he was working with the commissioners to determine if it's feasible for the hospital to bring dialysis and other applicable services to Carroll County.

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