Senior Dialysis Patients

Hi Beth,

In all that I’ve seen about home hemodialysis, there’s no mention of the elderly-most dialysis patients. I’m wondering whether: [ul]
[li] there is room for HHD for patients over 65 who’ve been on dialysis for years but would not be able to self-administer dialysis
[/li][li] a home care aide with a background as a renal technician could be retained by the family to administer the dialysis
[/li][li] if a health care agent or guardian would be able to enroll a mentally incapacitated dialysis patient in a home program

Sometimes the only thing keeping a senior in a nursing home is on-site access to dialysis. There must be a way to bring dialysis to this small, fragile population! ? I’ve been hopeful of HHD for nearly a year - was really excited about Fresenius’ UltraCare Staff-assisted Home Dialysis program - but so far have yet to learn the scope of it per the points above.

There is a need for staff-assisted home dialysis patients, not just for elderly patients but for any patient who cannot do dialysis independently and does not have a willing care partner. Although a few facilities in the U.S. do offer staff-assisted dialysis, most do this for patients who have coverage or can afford to pay for this added service. Dialysis facilities may prefer that patients hire their own care partners vs. providing their employees to do dialysis in a patient’s home because of reimbursement and liability. There is no Medicare reimbursement for a helper for home dialysis. However, some commercial health and long-term care plans and state Medicaid programs may cover this service. By Federal regulation, the dialysis facility that is certified to provide home training and support must test and document the compentency of any patient and/or paid or unpaid care partner.

Here’s info on Fresenius’ Ultracare at Home program:

One thing to consider is that since kidney failure is a terminal condition without dialysis or transplant, if a patient has developed severe cognitive impairment or other conditions that make dialysis of no real benefit, the physician should consider the patient’s previously expressed verbal wishes or written advance directive, if any, or the next of kin’s directions about whether to provide dialysis or palliative care. In some cases, the physician may advise the next of kin that dialysis cannot cure and will only prolong a patient’s suffering without allowing a quality of life that the patient was willing to accept. Sadly, too few people (not just dialysis patients) discuss their wishes or establish advance directives. Dialysis clinics are required by Federal regulation to let patients or their representatives know patients have the right to establish an advance directive and inform the patient or representative about the facility’s policies related to ADs.

Thanks for the information Beth.

I found the UltraCare at Home website last summer. When I called the 800 number I was told that only private pay was accepted. When I spoke to the person covering our area, I was told the program is available here but only private insurance was accepted. I called a couple of months ago to find out how much private pay costs since I’d found out about a Veterans Affairs program that might cover the cost; I’m still waiting for a call with a monetary quote. Last week I spoke with a local Fresenius center and first they said they didn’t know the program existed but they’d check. When they called back I was told the program is not available in our area. So difficult to get a clear, consistent answer from Fresenius!

Equating dialysis to being on life support was a concept that took a minute to swallow; after all, people live well on it for decades. The big questions are always when to stop dialysis, what is the patient’s quality of life. An elderly patient that can still interact with people, enjoy foods, music, and company while deriving some benefit from dialysis - when to say when? It would be clearer if the patient were semi-comatose but what about when things aren’t as cut and dried? And of course not knowing what the patient would’ve wanted…