Just quick run down on the money making world of dialysis. So a lot of patients starting dialysis have private insurance at first-whether it's a state ran or employee based, even if these people don't go back to work they are guaranteed anywhere from 18-36 months of coverage from their private insurance-IF they can't afford the premiums guess what? A grant program will help cover the costs-this is important to note as this is usually funded with donations from dialysis companies and manufacturers of dialysis related products-a tax write off. So with their coverage extended it's private pay rates all the way baby for a long period of time especially because the average life span of a dialysis patient is 3-5 years-most of the rest of their life is covered by this insurance….after this grace period they automatically go onto medicaid. At one time we had a patient's insurance paying the clinic $75,000 a month vs medicaid paying a little over $3,000 a month.
Then comes the next phase of fuckery, dialysis has it's own governing bodies called ESRD Network-it's their job to make sure everything is regulated and safe BUT what they have caused instead is a way for these companies to for go some of the normal checks and balances other medical providing facilities have like hospitals and nursing homes have.
A clinic is usually only state surveyed once every 3-5 years unless a substantial complaint was made.
I worked at these places for 10+ years and only had state survey 3 times.
Unlike nursing homes, for instance, that have a yearly survey no matter what and will come each time for incidents like a unwitnessed fall with fracture.
They also allow “patient care technicians” to be hired with no experience-I am talking NONE, you can go from flipping burgers to cannulating patients with 15 gauge needles and completing dialysis from the machine to mixing the fluids used-in around 6-9 weeks of training-after this they have a grace period until they take a test to be certified-it consist of information from a dialysis handbook and in clinic training. This would normally would be great-who wouldn't want on the job training and a certification without college? However they hire these people at extremely low wages as they aren't usually college graduates, expect them to work varied shifts that usually start around 4-5 am, deal with varied medical conditions, lazy RNs who don't help at all, being responsible for the water treatment, acid, and bicarbonate mixes for treatment, on top of the patients-some of are very angry with having to be on dialysis-ALL of which are going through the 5 stages of grief-kidney failure is a great loss. Turnover is very high for these techs.
Then they screw the techs and nurses over by how they stack the patients-most patients run anywhere from 3-4 hours, when I first started every clinic had two shifts-it varied on the times started but usually first shift is from like 5-6 am put on times and second shift is put on times from 9 is to 10:30 or so. You used to have time to safely take all four patients in your section off then put your next four on, I even worked at one clinic where we took everyone off 1st shift, took lunch, then put on second. Now they have what they call “the wave” it means you are constantly flipping your chairs, like trying to get a second shift patient on before the next 1st shift comes off…it's an all day fuck fest and very unsafe. Then per ESRD/state regulations they start sending 1 staff member home for every 4 patients that get off the machine so sometimes you end up taking 7-8 patients at the end of day vs just your 4 patients….it also means depending on your go home order of the day you could go home at 2 pm or 8 pm ya never know! Sorry this turned out to be a lot…just needed to vent.