Home Hemo Training

I have a patient that needs to be dialyized in the bed or a geri chair and could be at home if the training was available. She lives in a rural area though and there doesn’t seem to be access to meet her needs. Why don’t more units dialyze patients in the bed?

Where does she live? Have you checked on the maps on this site (http://www.homedialysis.org/v1/types/maps.shtml) or the database (http://www.homedialysis.org/v1/centers/search.php) to see if there is home dialysis somewhere nearby?

Not sure why more clinics don’t dialyze in beds. Probably depends on space, etc…

I’d be curious to know why the patient needs to dialyze in a bed. Can her condition be improved so she could dialyze sitting up a little bit more?

Most patients who do hemodialysis (in a clinic or at home) dialyze in recliner chairs. They need to be able to adjust the chair so their head can go lower than their heart in case they have a BP event. Would this work for her?

One possible reason why patients do not dialyze in beds in the U.S. (in some other countries patients dialyze in beds) is because when a patient is lying in a bed he/she feels “sick” and those around that person view him/her as “sick.” Having patients in street clothes dialyzing in recliner chairs is more like getting a “tune up” at the clinic or at home.

Assuming the patient has a helper who is willing to be trained, if she wants to dialyze in a bed at home or in a chair, this would be her option. Patients dialyze in a bed if they’re doing nocturnal dialysis at home or at a clinic (some Fresenius clinics and a few others offer in-center nocturnal dialysis).

If hemodialysis is out of the question, she (or her helper) could be trained how to use the peritoneal dialysis cycler at home. People use this type of dialysis overnight while they sleep in a bed or recliner.

Here’s an example of this:

When I’ve had to dialyze at one of the two acute dialysis units in my city, there are plenty of people dialyzing in a bed. It’s looks like people are very sick in there, and the whole thing is not a pleasant atmosphere.

Until I started training for home hemo, I had dialyzed for 2-1/2 years at a large dialysis unit for stable patients. Only reclining chairs there. You don’t even feel like you’re in a hospital. Most patients prefer it that way.


The patient cannot get up and bear weight for various reasons. She can be put in a lift to a geri chair and we are hoping to get the OP unit to agree to dialyze her in that manner. She is from a small northeast Texas town and will have to travel for her dialysis no matter where she goes.

I have worked on this for 2 months to no avail. All suggestions are greatly appreciated.

The goal is still to go home and possibly do dialysis at home. She is not a candidate for PD.


Does the patient have anyone that can help her do home dialysis. If that person could be trained, then the patient could dialyze in her home. There are a few staff-assisted home dialysis providers in the U.S. I don’t know this patient’s financial situation and don’t know whether they only accept patients with commercial insurance. You might also want to contact Quality Dialysis Inc. in Stafford, TX. They may offer staff-assisted home hemo or know someone that will do it in that area. If not, you can find some staff-assisted home dialysis providers on the Medicare website (www.medicare.gov) under suppliers. Look for durable medical equipment and do a search for dialysis.

Thank you so much for your help and suggestions.

Hi Nan,
There are possibly a few other options out there as well, but it will take a little probing. First call the local licensing board and see if they require a home-health care license in order for a Professional to dialyze someone in their home. If they don’t require one, then next go to the local center and ask if they will provide support services, equipment and the supplies to this patient, if you offer to become an approved provider of nursing services. The center can then bill for these services.

If they agree, then have this woman’s Physician write a strong letter of medical necessity, ( keywords: debilitated, homebound, non-ambulatory ), and also have the patient and yourself write a testimonial as to why home dialysis is needed. Next you’ll have sell yourself to the woman’s commercial insurer, using of course the support of the letters, and negotiate a fee per treatment for administering the treatments. You will have to provide credentials and they will then give you a provider number, prior authorization number, and information on how to submit claims.

You more than likely will need to be licensed as an LPN or RN. We have also had success in getting Medicaid to approve reimbursement for caregivers.

Let me know how you make out, and you may also feel free to correspond with me and ask for assistance at: eharding@dialysiscare.org

Good luck !
Elton Harding