I'm hoping that someone in this forum may be able to give me an idea of where I can go for help. My father has been on home dialysis for several years. In the past 6 months, his overall condition has drastically deteriorated, due to other health problems, mainly the inability to eat, anemia, etc. Although dialysis is still working, his doctor has told him that he is definitely dying. The prognosis was a few weeks to 6 months. His doctor has suggested allowing hospice to come in while still allowing him to continue home dialysis. The dialysis is not "keeping him alive", however, stopping dialysis would certainly hasten his death. The problem comes in because although his doctor has certified that he is indeed dying, where my father lives, the only hospice unit is refusing to allow him to continue dialysis. It's looking like his only option is to move to a state with different "Hospice rules" or to go off dialysis.
He understands that he is dying, but considers going off dialysis to be more or less active suicide. I've been reading for hours and everything that I've read seems to indicate that there are no definite rules that prohibit someone from receiving dialysis, IF they are in fact dying of other causes. I guess that my question is, if the state of Ohio says that he qualifies without discontinuing dialysis, aren't they subject to the same rules that the Indiana hospice is governed by? They are really trying to pressure my father and the family into ceasing dialysis in order to get some much needed home care. We have complete doctor support in trying to fight this with the Indiana hospice....but we're unsure how to proceed. Any ideas or experiences that might help? Thanks.

Dee

I'm a dialysis nurse in Louisiana, and I've discussed this same issue with a coleague of mine who is a hospice nurse. My suggestion is for you to contact the director(s) of the hospice care providers in your area. Explain to them that dialysis, while being a life supporting measure, is also a comfort measure. I've seen cases where dialysis was continued just so the patient isn't in respiratory distress. Personally, I consider it torture to allow someone to drown on their own bodily fluids.
If your father still has adequate urine output and dialysis is only provided to correct electrolyte imbalances, I would agree with stopping the dialysis, because it's just going to prolong his suffering. However, if he recieves dialysis also for fluid removal, explain to the hospice provider that dialysis is a comfort measure, and isn't comfort the whole thought behind hospice?

In the state of Ohio, you are permitted to continue dialysis even if hospice is asked to come in. I have a feeling that the Indiana hospice people are afraid that they will have to assume financial responsibility which is sometimes the case but there is a billing code for dialysis even with hospice involved. Medicare will allow this-call them. Please push for this as it will give your father comfort measures as he is nearing end of life.