In the U.S., options for HHD include HD like it’s done in an outpatient clinic 3 times a week, HD at home 4-6 times a week for less time per session, or HD done in-cener or at home for longer usually while sleeping 3 or more times a week.
Many dialysis providers offer home HD or PD. You can search a database on the full Home Dialysis Central website for clinics that do (search by zip code, distance and type of treatment–one type at a time) at https://homedialysis.org/clinics/search. You can also look up clinics in your state or within a set distance from you that offer home dialysis training and see the quality of care by the number of stars on the Medicare website at https://www.medicare.gov/dialysisfacilitycompare/.
In the U.S. people don’t buy or rent dialysis machines. Medicare and other insurance plans reimburse dialysis clinics on a per treatment basis no matter whether dialysis is done in the clinic or at home. Payment for home dialysis (HD or PD) includes equipment, supplies, and support services from staff. Medicare has a “bundled” payment system that includes most ESRD-related meds and ESRD-related labs. This booklet describes Medicare coverage for dialysis and transplant, including home dialysis.
To offer home dialysis training and support, the clinic must be Medicare certified and approved to provide training and support. Patients who do home HD or PD must be trained. An experienced RN trains patients to do HD or PD. If a patient needs a helper, that person is usually trained with the patient. sometimes for the full training time (3-6 weeks for HD) or less time if the patient is capable of doing all or most of his/her treatment without help. At minimum, helpers need to know what to do in an emergency and how to help the patient if he/she needs help and to recognize when help is needed. Patients have access to a team that includes an MD, nurse, dietitian and social worker for regular follow-up care.