Hospital Discharge needed but not able due to stretcher

ESRD Patient with trach. In the hospital for over a year. Needs a stretcher for dialysis to be performed. No facilities in the area can assist. Other: Peg tube, sacral wound and rectal tube. Patient is non verbal. Family wants to continue all care. Any recommendations to do what is best for patient?

This sounds like a very sad situation and one that is hard for all involved, including the patient. His medical needs exceed what an outpatient dialysis facility can provide since most patients do their dialysis in a recliner chair not a bed. Also, dialysis clinics have very limited RN staff with patient care technicians doing most of the hands-on care of patients. A PCT has a limited scope of practice that doesn’t include addressing wounds or rectal tubes. To get out this patient out of the hospital with his/her care needs might require placement in a long-term acute care facility. Some have onsite dialysis.

That said, you say the patient is non-verbal. How is his/her cognition and can s/he communicate using a communication board? I assume s/he doesn’t have an advance directive that names someone to act in his/her behalf if s/he cannot communicate his/her wishes. How does the family know what the patient wants and if his/her current health and living status meets the minimum quality of life desired? Has the doctor talked with the family/decision-maker(s) about what to expect over time with his wounds and nutrition and what level of pain s/he may be experiencing since s/he can’t tell anyone? Has the doctor talked with the family about how long the patient might live, whether his/her health may get better or may get worse? Has the doctor talked with the family about comfort care and hospice without dialysis and how the patient would experience that?

If the family wants him to live in spite of his health challenges, are they willing to take him home and take on the responsibility of learning how to dialyze him and running his dialysis 3-5 times a week? The next big problem is finding a dialysis clinic willing to train a family member or more than one to do his dialysis at home. I’ve not found it easy with patients in less tenuous health. Most home training is done at a dialysis clinic, but it can be done at home and Medicare and Medicaid cover dialysis equipment and supplies. Medicare won’t pay for a nurse or tech to do staff-assisted home dialysis. I don’t know if Medicaid in this patient’s state will cover that. Choosing home dialysis for a patient like this will require someone willing to take on a lot of responsibility and it sounds like his care needs are higher than most would be willing to take on.

What city and state are you in we provide home hemodialysis staff assisted we are located in Texas

That is good to know. Can you make sure that your clinic is listed as offering staff-assisted home dialysis in the Home Dialysis Central Find a Clinic database? You can add/edit a clinic at Clinic Search - Find a Clinic - Home Dialysis Central. Does your clinic accept Medicare? Original Medicare doesn’t cover staff-assisted home dialysis. What insurance do you accept that does cover it?