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.