Home/Nocturnal Dialysis in Nursing Homes?

Hello! Thank you for reading this note -
I am looking for daily alternatives to my uncle’s 3x per week hemodialysis. The sessions seem to wipe him out, removing much of his will to continue on. He’s been in a nursing home about 5 months now. I found a post from Beth W here (via Google) stating that Medicaid will pay for dialysis in nursing homes. Does this include paying for the machine itself? He is within 45 minutes of the only Nocturnal training program in upstate NY… thus I’m thinking if the machine cost hurdle is overcome, between himself, my aunt, and possibly nursing home staff, training and care could be covered. Any suggestions?
Thank you very much,

Dialysis can be provided in a nursing home. In most cases, the dialysis charges (machine and supplies plus visits with the home training nurse, dialysis social worker and dietitian) are billed through the dialysis clinic that trains the patient and/or caregiver to do the dialysis. It is my understanding that the nursing home does not get any additional money if they do dialysis on patients. Nursing home staff are very busy and may be reluctant to take on additional work.

Many people get confused about Medicare and Medicaid since the names are similar. Because your uncle has kidney failure, he may have Medicare (the federal program most patients have). Having kidney failure is one way you can qualify for Medicare. The others are age (65 or older) or having gotten disability checks for 24 months. If he has Medicare, it pays 80% of the allowed charge for dialysis. Since your uncle also has Medicaid, it will pay for all or part of what’s left over. You might want to call the clinic that offers nocturnal home dialysis and ask if they’ve ever had a patient in a nursing home do nocturnal home hemo and ask them if they would accept his insurance for this type of dialysis.

Another option to nocturnal home hemodialysis is peritoneal dialysis. Patients report fewer symptoms with peritoneal dialysis (also a daily treatment) than they do with 3x a week hemodialysis, plus they often have a more liberal diet. Medicare, Medicaid, and insurance pay for PD too. There are two types of PD – CAPD (manual daytime exchanges) and CCPD (automated exchanges overnight using a cycler). You can read about peritoneal dialysis on Home Dialysis Central under “Types of Home Dialysis.” I believe most patients who do their dialysis in the nursing home are on peritoneal dialysis. Depending on his learning capacity, he may be able to learn to do his own PD. There may be a clinic that trains patients to do PD even closer…maybe even the clinic where he gets his 3x weekly dialysis now.

What led your uncle to go into a nursing home? Is the plan for him to be there temporarily or long-term? Is he getting any kind of rehabilitation there? Maybe if he got some physical therapy and counseling he would have more will to live. Nursing homes often contract with physical therapists who see patients whose doctors refer them. The dialysls social worker should be available to help him cope with his condition and set goals for the future, especially if the social worker knows he’s having a hard time coping right now.