Home dialysis & vent dependant

My 72 year old father has been in LTAC for 100 days. Years ago he was diagnosed with stage 4 kidney disease and receives dialysis 3 times a week. He had a minor procedure to remove fluids from his chest. The doctor punctured one of his lungs during this procedure. 3 months later, he coded at home due to CO2 elevation. He was in ICU for about a month and was intubated. The tried to take out the tube a few times, but he continually became sick because he was unable to remove the CO2 while breathing. The medical team decided to do a Tracheostomy. He was sent to LTAC in hopes of weening him off of the vent. 100 days later and he is still vent dependant. During the day, he is off the vent, at night he requires the vent. Some days he is on the vent all day. The medical team made a mistake and forgot to put him on the vent and he is now in the ICU. They are wanting to discharge him, but in our area, there is no place that provides dialysis for patients on the vent. We are interested in home dialysis but we do not know where to start with getting trained to help with this. The hospital/social worker is not helping and they are wanting to send him home without dialysis. Please help!

So, let me get this straight. Hospital personnel failed to put your father on a vent that he’d required at night for some time leading to a stay in the ICU. Now without help to find a dialysis clinic that will admit him, the hospital social worker wants to discharge him from the ICU to home to die without dialysis. IMO, that pretty much takes the cake. It may not be that the social worker is not helping; it may be that clinics are not open to admitting a patient with a trach who is unstable (in ICU).

I have advocated with leadership of the major dialysis corporations to be more open to admitting patients with trachs. Clinic managers often say they don’t have the staff to take on the extra responsibility of performing trach care and suctioning for a patient on in-center hemodialysis. I’ve been told that dialysis clinics within these corporations don’t have a blanket policy to refuse to admit patients with trachs and I’ve been told their clinics will admit patients with trachs on a case-by-case basis.

What kind of home dialysis are you interested in? Most patients and partners train for peritoneal (PD) or hemodialysis (home HD) at a clinic. Dialysis regulations allow patients to be trained at home, but whether a clinic will do that depends on staffing and the number of patients needing training. PD training is relatively short (often a week), but home HD training can take 3-6 weeks depending on how fast the patient/partner learns.

Medicare won’t pay for a helper if there’s not a family member or friend to volunteer. Other health plans may cover a helper under the private duty nursing benefit. Is there a family member or friend who is willing to learn how to do dialysis and the other tasks associated with dialysis? To understand a little about what home dialysis requires, here’s a blog that describes two checklists of tasks–one for PD and one for home HD. https://www.homedialysis.org/news-and-research/blog/99-introducing-the-new-partner-agreement-on-tasks-for-home-dialysis-path-d-tools-comments-welcome.

Is your father alert and oriented or is he cognitively challenged? Is he bedbound or can he get up and sit in a chair, transfer from the bed to the chair, stand, walk? Is he getting physical, occupational, and/or speech therapy to improve his functioning? The more functional he is, it seems like the more willing a dialysis clinic might be to admit him as an in-center or home dialysis patient.

Here are a couple of blogs about patients with vents.