After eight years on in-center (including nocturnal) dialysis, I am working to overcome a conservative bureaucratic attidute to home treatment. Since it is not an accepted practice in Israel, despite the country’s very advanced and progressive medical services, my current effort is to persuade the national health insurance fund (the “Kupa” in my letter) to pay for it all instead of reimbursing my hospital clinic. Meeting with the powers- that- be are planned for early next year, hopefully on the basis of the folowing letter, in which I outline my personal understanding of and approach to the hoped-for switch from in-center to home dialysis. If I succed, I’ll be something of a pioneer in these parts, opening up the possibility for other interested patients. However, if it doesn’t happen now, I’ll know, at least, that it can’t be far off.
My letter:
Following your recent visit to and discussions at my hospital in Jerusalem, I would like to present the case for home hemodialysis from a personal perspective. While the objective medical benefits were explained fully by the director of the nephrology department, his head nurse and social worker, I feel it important to outline the request from my own point of view.
As an active individual and a journalist who would like to resume full-time writing, home hemo, as it is known, would open, for me, new windows on life in general and creative productivity in particular. As many patients who have experienced the switch from in-center to home hemo put it, I would “get my life back.” Active as I am – I travel frequently and have a full social and family life - the need to attend a clinic three times a week imposes virtually insurmountable burdens and discomfort on my lifestyle, professional plans, overall wellbeing and psychological demeanor. Quite simply, the possibility of doing dialysis at home, with the keen assistance of my wife Betty, who has started training to operate the machine, would grant me flexibility, improved health, higher productivity and the personal privacy I seek and need.
For various medical reasons, which I would be happy to detail separately, I am not at this time considered a suitable candidate for a kidney transplant or the PD method of treatment. For me, therefore, this leaves home hemo as the only viable alternative to in-center attendance for the rest of my life. It is clear, from the scientific evidence, that where daily and nocturnal dialysis can open new, positive horizons for a compliant, efficient patient, treatment three times a week for four hours is, ultimately and inevitably, a regressive process. This, needless to say, is despite the extraordinary care I receive from and the affection I am shown by the doctors and nursing staff at my Shaarie hospital clinic in Jerusalem.
Home dialysis is well established in Europe and is being adopted increasingly in many parts of the United States, Australia and other countries. Scientific studies show that daily or nocturnal “while you sleep” treatments in the self-controlled environment I envisage, may result in overall lower healthcare costs for end-stage renal disease patients.
While I am fully aware of the cost factor for the Kupa, there is no doubt whatsoever that the installation of a dialysis machine in my home would be financially effective in the long, even short, term. Any request to subsidize the cost of a kidney transplant is avoided while hospitalizations and drug expenses are reduced. My wife and I are aware of all the ramifications, from a medical and personal standpoint, and feel it is a vital, even indispensable, transformation to sustain the quality and duration of life we both seek, and feel we deserve.
Enclosed, for your interest, are some recent articles on the advantages and convenience of home heomo for patients capable of controlling their own lives. The mounting evidence speaks for itself, I think. It is only a matter of time until it becomes a standard procedure, with the understanding and incentive of progressive health authorities. For my own benefit and taking into account the eventual long-term advantages for all ESRD patients, I would like to take this step forward, with your assistance and encouragement.
May I suggest that we meet, at your convenience, to discuss my request in greater depth from all aspects, personal, medical and financial.
Yours sincerely
David Eppel
but I hope you get home sooner. You are doing a real service for those that will follow you on the ESRD road.