Health promotion is the desired objective of dialysis treatment. Achieving the highest level of functioning not only improves the life of the patient but rewards the staff through the positive feedback that improvement produces. The facility is rewarded by a stable population producing a more secure stream of income. The therapeutic environment is improved through better communication, positive attitudes, and more active participation of patients in their care. When maximum health is the focus of care, activities to achieve health are part of routine clinical contact, not additional effort requiring more staff. Fundamental to achieving health is adequate dialysis, control of anemia, good nutrition, and attention to comorbid conditions. The "Five Es" Life Options model of rehabilitation is a pattern for pursuing health and life enhancement. Encouragement is the positive attitude and expectations for each patient. Evaluation is individualized planning and periodic assessment of progress. Education prepares the patient for participation and responsibility. Exercise (on dialysis and off) improves physical capacity and well being. Employment is sought for those of working age and capability. A number of facilities have shown the effectiveness and benefits of these practices. In addition, using health status/quality of life measures to obtain patient-reported assessment of condition allows objective scoring. Comparisons and compilations can be made to evaluate the effect of interventions or illness on status. This can be accomplished for groups or individuals to document the effect of health promotion.