Is it possible to hire a private duty PD nurse to help with an elderly patient’s PD exchanges while they regain hand strength via in-home physical therapy?
Hi MikeMB. Sure, it’s possible to hire someone to help, and it’s a good idea. The challenges will be to find a nurse who knows PD, and to pay for it, since most health plans in the U.S. are unlikely to. The patient’s dialysis clinic may know of a nurse who would have the knowledge and be willing. In Canada, assisted PD is done routinely. We are a bit behind here in the U.S…
Thanks for your quick reply! Yes I read that Assisted PD is not reimbursable by Medicare in the US yet. I was wondering if this was the reason I can find little information on Davita forums or Home Health Care agency list of services for example. Is there a systematic way for searching for private duty PD nurses in the US besides word of mouth?
It is a shame because the alternative is have her (my mom) admitted to a skilled nursing facility for rehab and ensure the facility has PD skilled nursing staff. This would be way more expensive and my mom wants to be at home.
Of course she wants to go home! I am not aware of a systematic way to look for private duty nurses, but Google may be of assistance. I really think that starting with her clinic is your best first bet. Home Health Agencies don’t generally tend to have dialysis skills, though you’d think they would. I’ll see if Beth Witten can add anything useful.
Mike,
If it’s temporary then the facility at which she is being provided dialysis should help.if I am training someone who isn’t ready yet, I come in the evening and put them on, and come in AM to take them off. It all always boils down is how hard is a nurse willing to work for the patient.
I know here in Michigan I am working with skilled nursing facilities to provide this staff assist service, because it currently doesn’t exist. We will be using techs, because if a support person caregiver/ non medical patient can treat themselves, there is no reg that says you can’t hire a tech or a standard caregiver and train them. DaVita should be able to provide retraining up to 5 days for “a change in caregiver.” This is extra financial incentive to the facility for those 5 days (sometimes this sadly is what moves them).
I would find someone I trust and have them trained for the interim. The amount you will spend for a private duty nurse will be expensive, and getting a PD nurse even more a challenge.
Thanks for the consult and reaching out to your colleague Beth for other ideas. I will definitely be contacting her clinic. Can family members be trained to assist with PD or is that strictly forbidden except for licensed and trained PD nurses? She was on a cycler but treatment has been changed back to manual exchanges 4-5 times/day. I imagine from a practical standpoint, family will have to supplement a private duty PD nurse if it is legal for us to help in that way.
Most folks who help with PD are family members who are trained by the PD nurse in the clinic. I thought you lived too far away to make that work, but shouldn’t have assumed. So, you may have a doable option! It’s easier to help with cycler PD, since there is just one connect and disconnect, but if someone has the availability, manuals would work, too.
Thank you Josh for raising some extremely interesting points. So could we as a family pool our resources, hire a “standard” care giver to handle ADLs not covered by a Home Health Care company doing the rehab, then have that “standard” care giver trained? How much would it cost the family to have this “standard” care giver trained? By the way my mom is in Detroit.
I am in MD but my sister is still local. She would be unable to carry that burden herself so I was trying to brain storm on how to share the Assisted PD burden. Can only family members be trained at the clinic or, as I was speculating with Josh, can “standard” privately hired care givers also be trained there? Is there a limit of how many people can be trained? And of course how much does it cost?
There is no clinic charge to train a family member–it’s just part of PD training. You’d have to ask her clinic if they would have any problem with training multiple family members. There are no rules for this, so each clinic makes its own policies. I do think it would be important for everyone to help your mom often enough that they remember the steps–and also put together a step-by-step document with photos that could hang on a wall and refresh memories of everyone who takes on this role.
Mike,
I apologize if that wasn’t clear. DaVita should never charge a patient for training, they can charge Medicare for additional training. When you create that family pool, just make sure everyone attends the classes and nobody misses out. If you wash your hands, wear your mask, and use appropriate technique all will be well.
Where are you in MD? I actual have a dialysis nurse who lives there I talk to frequently.
For as long as dialysis has been done at home, when a patient can’t do dialysis independently, a family member, friend or paid helper can be trained at the dialysis clinic to assist. The amount of help the dialysis regulations allow a helper to assist as much as needed after training.
There are two options for PD. One like Josh wrote about uses a cycler machine overnight while the patient is sleeping. There may be machine alarms that must be addressed to get the full treatment. The other option is 4 manual exchanges a day.
I have researched this, but haven’t been able to identify clinics offering staff-assisted dialysis for PD. I can definitely see it as a service for the clinic to send a trained nurse or tech to the home to provide more training, to make sure the patient remembers the steps, or to provide re-training. However, I wonder if any clinic would be willing to send a nurse or tech to spend the night with a patient (or when s/he uses the cycler during the day) in case the cycler had alarms that the patient couldn’t address independently. I wonder if a clinic would send a nurse or tech to the home 4 times a day (breakfast, lunch, dinner, bedtime)?
When I worked in dialysis, there were nursing homes in my area that offered PD for their residents. If she needs short-term rehab to be able to do PD independently, she might get hand strength and flexibility faster with more intensive rehab that could be done in a rehab hospital or nursing home that offers on-site PD. I realize that this is not her preference but might be an option. It would be important to check out the place where she would go to be sure that the care provided is good. Medicare has a website called Nursing Home Compare that assigns stars for quality of care and patient satisfaction. You can find that on the Medicare site at https://www.medicare.gov/care-compare/?providerType (choose nursing home). there are several filters but unfortunately, none for PD. The dialysis clinic or the state survey agency for her state should know where PD is done in a nursing home. Surveyors visit dialysis clinics and nursing homes. The clinic should have a poster with the phone number for the state survey agency.
Josh, I live in Bowie, MD. I’m curious if I could be trained at a Davita clinic out here in MD so when my turn comes up to help out in Detroit I will be authorized by the local clinic to do so? Or does the training have to be hands on with the intended patient?
Thanks Beth that is awesome info. The take away from you @Beth_Witten_MSW_ACSW and @joshdipzinski is that the regulations allow paid help to be trained at the clinic. We just need to figure out the logistics. I am looking to increase the “family pool” of trained PD assistants to include paid help my family would hire. This way we could better mange peoples work schedules, location, burnout etc., challenges. My mom is very sharp still, has a very good relationship with her Davita nurse and is very familiar with manual and cycler exchange techniques. At his stage she just has lost function in her hand that prevents her from hooking up, clamping tubes and lifting bags. She would be actively working with her family and paid help to ensure everything is done right. 
We anticipate her recovering this hand function and then needing less assistance.
Thanks @Dori_Schatell! that is an excellent suggestion about having our own detailed step by step instructions with pictures. @Beth_Witten_MSW_ACSW I also do take your point that maybe a SNF with more intense rehab might be the better approach so we will take all of this into consideration.
I think we just need to start interviewing “standard” caregivers and their private duty employers to see if they would be willing to go through the PD training at the clinic so we at least have out options lined up to evaluate. We also need to check with the clinic to see if they are alright with training this “family + paid caregiver pool” of PD assistants.
Thanks all for helping me work through this on a Saturday!
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Wait Mike, what about Detroit? I am located in Michigan and I cover the entire state of Michigan. Perhaps you should shoot me a call tomorrow. 810-223-1938 and I can assist more.
Beth: I must comment on your two styles of PD. Please do not forget Premier dialysis speciality is once a day icodextran (extraneal). 10 out of our 11 patients are on this CAPD modality. They fill up with 2-2.5L at night with one manual bag and disconnect and do as they wish. No cycler, five case of solution delivered a month (each case contains 6 bags). It’s a really beautiful way to do PD the preserves the peritoneal membrane because as you know icodextran is dextrose free. We have patients at 6 years plus with no prescription changes! Just wanted to comment so you can add it to your PD options tool book!
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Josh, once a day with icodextrin?!!! There’s your blog topic!
I was not aware of the once a day PD with Icodextrin. I had heard of people using the cyler overnight and Icodextrin during the day. I’d be interest in knowing more about it. Do you have a reference?
The examples listed above are times when people have used so much dextrose solutions their Kt/V cannot be achieved other than the use of icodextran. Every 2L bag of extraneal that dwells 12+ hours provides 0.55 of Kt/V and every bag of 2.5L can provide 0.63-0.70.
When you use extraneal as your first line of treatment, you preserve renal function better and supplement with the least amount of dialysis required to prevent uremia.
There are a few studies with what we do, 5-6, but not nearly enough. I have personally done this treatment with 55+ patients with amazing success while we get them transplanted.