Why Do Not More Clinics Push Home Dialysis?

Trauma Columnist · Jun 29, 2014

You will find that home hemo is the wave of the future. Just search the FMC website for instance.

NDXUFan · Jun 29, 2014

I am very glad to hear that :) Yes, I have been on that site. many times.

Dodongo, APRN, NP · Jun 29, 2014

The clinic I work for always educates the patients on home HD, but for whatever reason, they aren't interested. It's also difficult for them to find someone who is willing to be their "dedicated HD helper" at home. I think it seems like a lot of work for them. My 2 cents.

Erikadawn RN · Jun 29, 2014

I talk to pts all the time about home hemp they usually just say they have no help or don't want to do it. I especially ask my more difficult pts who always complain and never are happy with anything why they have not considered. If I was on dialysis I most definitetly would

westieluv · Jun 30, 2014

FMC employee here, and our clinic is going to be pushing this very heavily in the near future. I have also been told that this is the wave of the future. If it saves the government money, you can bet it will be done as much as possible and that there will probably eventually be consequences for not having "X" number of patients on home HD.

SmilingBluEyes · Jun 30, 2014

You can lead a horse to water.............................

For the record: We educate every single new patient that comes in, plus re-assess their interest every year on their annual interdisciplinary assessments. We definitely do our part.

The facts are the facts, however. Our (the majority of) patients are not only not interested, but don't want to hear about home hemo/PD. VERY few will even express enough interest to be educated and still more choose not after hearing about it. And we have had several come back to IHD d/t it being too much to handle (too much work mostly) or their PD catheters failing at disappointing rates.

Also, I have had a few pts come back d/t missing the social interaction that in-center dialysis brings. They felt isolated at home and came back to feel "in touch" with their world again.

The onus does not lie on the clinics not encouraging home hemo/PD but in the lack of interest in our dialysis population.

It (home hemo/PD) may be the "wave of the future", but we still have a long way to go, making it desireable and even do-able for many patients. You can't make them do it, despite education; the only way I see pushing them into it, is having them bear the cost of the difference between home and in-center,---or offering significant monetary incentives. Too many just are not interested.

NDXUFan · Jun 30, 2014

Very good posts. The main reason that I went to home hemo is that I was very unhappy with In-Center dialysis, not enough dialysis. Many very unrealistic demands and standards. Too many that wanted to demand a standard that they were unwilling to live, themselves. Then, I read about Nocturnal dialysis and you could do it at home. I thought, "I am so out of here." Now, I have dialysis on my schedule, what works for me. If it is getting done, kidney specialist does not care. I do not understand if they hate it so much, why do they not want to leave and go home? I agree, does not make sense.

NDXUFan · Jun 30, 2014

Probably so, government needs to mind their own business.

NDXUFan · Jun 30, 2014

Believe it or not, many countries do not require or do not mandate a "helper." Having worked in public safety, I think it is overkill on Nocturnal Dialysis at a blood flow rate of 300. The Nursing staff at Indiana would agree with me. I understand in certain cases or patients, a helper would be a very good idea. However, it would depend on the health of the patient. I would love to have someone help me, but, if they do not, it really does not matter. There are many push button systems that you could use and they are not expensive, as well. If Nocturnal is being done every day, you generally never have any type of fluid issue as it is working somewhat like a regular kidney. :)

SmilingBluEyes · Jun 30, 2014

The gov't needs to mind its own business, but as long as big payouts for Medicare are involved, you can bet your last dollar it won't happen. That is the real reason home hemo/PD are "the wave of the future". It's never been TRULY about what is best for patients, but what is most expedient and cheapest for the government, and the for-profits running the show---- as is almost always the case.

SmilingBluEyes · Jun 30, 2014

Very good posts. The main reason that I went to home hemo is that I was very unhappy with In-Center dialysis, not enough dialysis. Many very unrealistic demands and standards. Too many that wanted to demand a standard that they were unwilling to live, themselves. Then, I read about Nocturnal dialysis and you could do it at home. I thought, "I am so out of here." Now, I have dialysis on my schedule, what works for me. If it is getting done, kidney specialist does not care. I do not understand if they hate it so much, why do they not want to leave and go home? I agree, does not make sense.

I think we covered "why" already in several posts. Most of our patients prefer IN-CENTER dialysis. Again, if they choose not, despite being educated, what would you have us do? We even go as far as have current home dialysis patients come in and talk up the benefits you outlined here, to potential home dialysis folks. Not sure what else we could do. Oh and I am in Fresenius.