Getting Set Up With Home Dialysis

Kidneys are the filters of the bloodstream. As blood flows through the body, it passes through the kidneys where wastes are removed and sent to the bladder. Failure of the kidneys to filter the blood results in toxic build-up of waste in the bloodstream, and is fatal without intervention.
Although kidney transplants have a high degree of success with patients, many wait an average of 3-4 years on a donor waiting list, and others are just not medically fit for a transplant. Without a replacement kidney, dialysis is the only other viable option.
Renal Dialysis performs the kidney’s job of filtering waste and toxins out of the blood stream. There are two types of dialysis: hemodialysis and peritoneal dialysis (known as HD and PD). In peritoneal dialysis, dialysate fluid enters the peritoneal (abdominal) cavity via a catheter. The fluid collects waste and is then drained out of the cavity. Hemodialysis is the process of passing the blood out of the patient’s body, filtering it, and returning it to the body.
When Shirley Allen’s kidneys failed, she was started on hemodialysis at a regional kidney center, which was about 30 miles from where she and her husband, Richard, lived. It was a difficult ride for Shirley, who felt weak and tired after her treatment and had to wear portable oxygen as well. Their life revolved around the hospital’s schedule, and they often received a call the night before treatment to inform them of their appointment time the following day. It was also crucial to arrive on time for treatment, because of the hospital’s tight schedule.
Richard had recently retired, and felt up to the job of learning to administer dialysis at home. The hospital that administered dialysis also had a program in place for helping patients who wished to do home dialysis. Richard attended classes for about three weeks and went through the process of hooking his wife up to the machine, mixing chemicals, and programming the computer settings with the supervision of the staff.
Through Medicare, a home dialysis and RO (reverse osmosis) machine was purchased, along with the supplies necessary to do the job. Medicare also covered $400 for home improvements to accommodate the equipment and plumbing needs. Hot and cold running water needed to be plumbed into the bedroom, and an area of the floor had to be tiled for the dialyzer and the RO machine to stand. Cupboards and shelves were added to store some of the supplies. The actual cost for the Allens was about $770.00, and they had to pay the difference out of their own pockets. Considering all of the major costs that were covered, that wasn’t a big deal.
The kidney center provides technical support 24 hours a day, 7 days a week. Problems with the equipment or a concern about the patient’s condition can be addressed by picking up the phone and calling in. During one dialysis session, Shirley’s breathing became increasingly difficult, and the nurse Richard spoke to advised him to call 911. Help was on its way, and Shirley was brought back to the hospital for further evaluation.
If there is no family member to administer home dialysis, Medicare will pay for someone trained in dialysis to come into the home and perform the task.
For Richard and Shirley, home dialysis has allowed them more control over their lives and schedules. They don’t have to fight traffic, and Shirley can have her treatments in a more comfortable setting.
If you are considering home dialysis, keep in mind that this isn’t the answer for everyone. It requires a suitable place in the home for setting up the equipment and adding plumbing facilities. It requires a lot of work on the part of the person administering dialysis. It requires that someone be comfortable working with technology and troubleshooting problems. Can you remain calm in an emergency? Even with 24-hour help available by phone, how soon can an ambulance get to your home if something goes wrong? If you prefer to have a trained person administer dialysis, are there any available? If something goes wrong, do I have a case with medical malpractice lawyers? Will the hospital help you find someone? What does Medicare pay someone who provides this service? When we checked with Medicare, we were told that they paid $40.00 per session.
There’s a lot to consider and prepare for when doing home dialysis. Do your research, ask lots of questions, and find out what your Medicare plan pays for.

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