A question

Hello everyone. First time on this board so please be gentle.
I have what may be a silly idea or question.
We are out here where we must travel 30 to 60 miles one way for dialysis.
This can be somewhat of a pain. There are several of us from the same general
area that must travel to the dialysis unit. Carpooling will not work, due to different
times, and the same for having a public transport unit.

We have a local hospital, but they know nothing about dialysis, and we have encouraged
them to get into dialysis. But no interest.

So, trying to figure out something, here is an idea that we’ve come up with.
We would call it “community dialysis”…what it would boil down to is to have
a room at the local hospital, we would use Nxstage dialysis units, so no
headaches with water treatment. We would run 6 days a week. We would
also hire 1 nurse to kind of oversee some things, and if needed put the
needles in. I guess you could call the nurse a dialysis partner.

We would not be a “unit” so not as much red tape to go thu.
The room would either be “donated” by the hospital, or “rented”.

since the units are so simple, we would only need 1 person to do it all.

I was wondering if this has been tired anywhere else.

This would be about our only option, since nobody is interested in starting a unit.

Thank you.

I have heard of patients in Hawaii who were having to travel hours to get to dialysis. They advocated to get a building in their community turned into a “dialysis home” operated by the county where patients could dialyze. I don’t know if the patients live in the “dialysis home” or if they travel there for dialysis. I can’t tell from a quick review of their website whether the patients have their own partner do the dialysis for them or if they have paid staff doing it. I’m not sure if this is similar to what you were thinking, but you could contact the people that worked on this project to see if you can take away anything helpful from what they did.

You could contact the State Survey Agency in your state to ask about the feasibility of an idea like this, but here are some thoughts that I have. You can find the contact information on the Medicare website under helpful contacts. Choose to look for an organization and then ESRD State Survey Agency.

Just curious…Are any of the patients who are currently doing in-center hemodialysis able to do peritoneal dialysis or home hemodialysis? Many people on dialysis do in-center dialysis because they haven’t been told much about other options and what they have been told may not be accurate. You can read about all 5 types of home dialysis from the Home Dialysis Central home page. Most people who do CAPD or CCPD do it without help. Most (but not all) clinics require home hemodialysis patients to have a partner. Clinics that are certified to train and support home dialysis patients take their time and assure that patients (and partners if needed) feel competent and safe doing their own treatments. In fact, patients and their partners are trained as well as dialysis technicians who perform dialysis in-center. As you said, the NxStage machine should not be difficult for a patient and/or partner to learn how to set up. In training patients and partners learn many other things, including how to troubleshoot when there is a machine problem, symptom, or something isn’t working as it should. They also learn how to test the water to be sure that it’s safe, how to set the machine to remove the amount of fluid that needs to be removed based on the patient’s weight, how to draw labs and eat according to lab results, how to do needle sticks, how to monitor and record vital signs and treatment information, and much more.

I suspect one of the things that people did in Hawaii is to show how many dialysis patients lived within a reasonable driving distance from the location they wanted to use. Knowing the numbers may help to convince your current clinic, the hospital, or another entity to open a dialysis clinic in your area.

Dear “tiredandconfused” (and Beth)

Beth, I shouldnt really be adding stuff on your page but, I read the post and …

Yes … to answer the question from an ANZ point of view, our New Zealand colleagues across the big ditch (the Tasman Sea) have used this very model for some years now - and, at last report, it works very well indeed. The patients all self dialyse (unaccompanied and unsupervised) … they are all home trained first … in a community house in suburban Auckland. In fact there are, I think, several such facilities but they would be able to answer that more accurately. They (the patients) set their own rosters - do daytime, overnight, long hour, short hour and/or high frequency treatments as per their personal preferences and integrated through their self-roster system.

The team at Middlemore in Auckland are the trend-setter unit at this. We have been keen to set up a similar model in Australia based on their experience but, as yet and to my knowledge, we havent got a community house program going yet as here.

The team in Auckland perfected this program some years ago though, and I am quite sure would be more than happy to share their experience. The best person to contact there wouold be Mark Marshall - or, probably better - as Mark is busy as busy - the NUM (Nurse Unit Manager) of the Home Therapies Program at Middlemore Hospital in Auckland.

John Agar