My mother-in-law (65yrs)has been taking care of my father-in-law (66yrs) at home and doing all of the work to set up and take down for his home dialysis treatments. It has been great compared to going to the hopsital at 6am and he seems to be doing much better now. The problem is that it is too much for my mother-in-law to continue to be responsible for everything and her health is starting to become affected by it. Aside from bringing in a sister with three kids who will create even more stress to the situation what are her options? Will senior housing complexes be willing to allow for a dialyis patient? Will Medicare pay for a nurse to assist with the setting up and taking down to relieve some of the stress? Help!

You don't say where your in-laws are but in general payment for home help is not available. There are exceptions, for instance in Seattle a home helper stipend is available but this is through the provider rather than direct from Medicare.

I do self care at home: could your FIL get more involved in his own care? Check out the message boards at Home Dialysis Central for an active community of people doing all kinds of home dialysis under a variety of situations:
http://www.homedialysis.org/phpBB2/

One thing to consider is that there are several new machines designed for the home market that can lessen the burden of home dialysis as far as set up and maintenance. The NxStage and Aksys PHD are designed to provide dialysis 5 or more times a week and I think the new Alliant machine is designed for standard three day minimum.

The easiest to use machine in the world wont help if it is caregiver burnout, something that is always a possibity. If your MIL is doing things your FIL should be doing then that can create an unsustainable situation. It takes a lot of communication to prevent caregiver burnout.

Which dialysis machine is your father-in-law using? Which machine you use can make a big difference. As Bill says above, some machines are better designed for the home than others. The NxStage machine requires very little setup. All you need to do is insert a cartidge into the machine that has the tubing and connect an already-mixed bag of sterile solution. The bag is heavy. There is no water system to maintain. You may want to ask someone who uses the machine for input. The Aksys PHD jut requires you to replace a small bicarb bottle and small acid bottle after each treatment. The machine does everything else. The PHD requires some upkeep for the water system (change filters, add salt to the softener, etc). You don't have to make the bicarb solution, or disinfect the machine. Of course, you have the same amount of work to prepare the connection to the patient. The screens on the machine are also written to provide more information to better assist the non-medical people who use them.

Ask the clinic if they recommend using another dialysis machine that requires less work. Good luck!

Hello,
I provide staff-assisted hemodialysis to patient's in their homes in Massachusetts, and get reimbursed from their commercial insurers.
Not everyone is guaranteed, however every commercial insurer has a case review board. I have the Physician write a letter of medical necessity, we in turn submit a clinical and environmental assessment, and most importantly we have the family members write an affidavit on the importance of being at home.

In most instances if a patient is approved it is the result of a benefit exception. We then negotiate with the Insurer and enter into an extracontractural agreement to provide the service. In regards to the dialysis caregiver, I employ several, however there are numerous competent caregivers working in the clinics and hospitals that are always looking to moonlight.
If you have any other questions, feel free to call me at 781-264-4656.