Distance from care

I have a relative considering Home Dialysis. However, I have concerns about how far they live from a hospital. They live over an hour away. Response time, give the distances, by EMTs are not quick either.

How far is too far away when considering Home Dialysis?

I see no issue here …

In Australia, we manage home dialysis patients from distances of up to 3000-3500 kilometres away.

Provided that the communication lines are clear and available, that local medical services are engaged (in the sense that they are (1) fully aware of the patient and (2) have clear lines open to discuss management and through which to seek advice), then there is no issue with distant management. We do it every day.

I do not see why the US should be any different, despite the fact that the US is actually far less urbanized than is Australia.

Indeed there are vanishingly few problems that cannot be dealt with calmly, sensibly and safely, over the phone, between a well trained patient (NB: we do not train a carer here but train the patient only) and a well trained home dialysis staff member.

In our world, where home dialysis is the norm and not the exception, an hour away would seem like round the corner to many of our patients. That said, more patients on home dialysis live in urbanised cities than in rural and/or remote Australia, but rural/remote (up to 3500 km away from the parent unit) is not seen as - nor is it - any sort of contraindication to home care.

Really - the myths around the risks of home dialysis sometimes astound me … and I often wonder why and/or how they have arisen in the US. It is nothing short of extraordinary … and very, very disappointing … to find that it is so. I can guess at the possible origins of these misconceptions - but it would be impolitic of me to say what I really think.

Sometimes things are best left unsaid.

Oh, go on, Dr. Agar, and say the unsaid. You know you want to…LOL! And I want to hear them!

While it is best that I don’t, I will go so far as to say that from an outsiders viewpoint, it seems (much as my answer in the ‘carer’ thread adjacent to this thread suggests) that home dialysis has suffered from a mix of 4 main ingredients:

inadequate education in, understanding of, and exposure to the ‘possibilities’, outcomes and benefits of HHD - not so much from the patients’ aspect but from that of professional;

a culture of fear and of misunderstood and/or magnified risk that arises from that inadequate education, understanding and exposure;

a culture of defensive medicine, perhaps fueled by legal risk and its’ attendant aggression;

a theoretical though unsubstantiated risk to income, should a significant tranch of patients depart facilities for home-based care.

Enough said.

Post closed.