COVID-19 infection risks are associated with long term care residents requiring outside medical appointments, including dialysis. These risks are impacted by the processes around these medical appointments, including transportation and the status of infection control practices at the dialysis center or other community medical provider. Everyone plays a key role in reducing the risk of infection spread, including the long term care facility, dialysis providers, and state and federal policy makers and partners. Improved and regular communication among these stakeholders is critical to improve outcomes and minimize infection risk. 

Long term care providers have identified some challenges in working with dialysis centers to manage COVID-19 risks for residents who require dialysis. These challenges include: 

• Differences in infection prevention and control practices and standards, including PPE, dedicated staff, and social distancing. 
• Transportation to and from the dialysis center, including residents traveling long distances due to closures of some dialysis facilities, especially in rural areas. 
• Challenges with guidance and practices around cohorting and isolation for dialysis patients.

The following are potential solutions that may be helpful to minimize risk and improve outcomes:

• Seek opportunities to revise schedules with the dialysis center to minimize co-mingling of long term care residents with community patients in the same room during the same dialysis session, utilize separate spaces for each group, and facilitate dedicated staff and equipment for each cohorted group. 
• Ask the dialysis center to ensure social distancing between all people, including patients and staff, using physical separations whenever possible due to risk of asymptomatic spread. 
• Seek information from dialysis centers about their infection prevention and control policies and procedures to identify areas of opportunity for process improvement, including staff and community patient testing based on prevalence in the surrounding community. 
• Request timely communications from dialysis centers for any infection control issues or lapses to the nursing home, so that the nursing home can be aware and manage accordingly. 
• Seek and create alternative approaches to dialysis during COVID-19 pandemic, including more on-site dialysis opportunities within nursing homes where possible.

Reach out directly to the dialysis centers your facility works with to engage in dialogue about current practices and seek collaboration in areas for improvement.