Your father is very lucky to have such a loving family. We see two groups of folks who do home dialysis. One is otherwise healthy, often younger people who want to have a good lifestyle that may include work and travel. The other–your dad’s group–is older, very ill (often with multiple medical problems), and has caring loved ones who want to bring them home.
Medicare will pay for dialysis at home just as they do in-center. Most home hemodialysis programs require a partner. For the “group one” folks, we strongly recommend that the person who gets dialysis be the one to do as much of his/her own treatment as possible. For folks like your dad, one of your family would need to commit to doing the training and the treatments. His dialysis could be done as short treatments 5-7 days/week, or at night while he sleeps. Either would allow a more normal diet (important for someone who has diabetes and already has diet limits) and fewer fluid limits and medications. The more dialysis he gets, the fewer diet/fluid limits and drugs he’d need to take.
As far as the other nursing care he is getting, you’d need to talk with the nursing home. They could give you an idea of how much help he needs with activities of daily living (ADLs) such as bathing, toileting, dressing, and feeding himself. That information will help you and your family figure out what he’d need and how much of it might be paid for by Medicare, which, I believe, prefers to provide care in the “least restrictive setting” (i.e., home is better than institutional care). But I’ll ask Beth to weigh in on options for home nursing care under Medicare.