Home Dialysis: One Way to Help More People on Dialysis Work

A Rationale for Home Dialysis

There are many reasons why someone with kidney failure might want to learn about and do home dialysis, like limited finances or insurance, poor transportation options, a need to care for loved ones at home, to have more control, and a desire to work. Any form of dialysis that lets a dialyzor choose a dialysis schedule is "work friendly". However, nationally, only about 20% of working age patients work and fewer than 20% of facilities offer in-center dialysis shifts after 5 p.m.¹ Since home dialysis allows treatments to be scheduled around work, if patients are fully informed about all options for treatment as required by ESRD regulations, why don't more patients choose home?

Home Partners: Necessary or Not

Most people can do PD independently. Those who are willing and able can and should also be taught to take primary responsibility for most—if not all—of their home HD. It can profoundly reduce stress if all a care partner has to do is provide an extra pair of hands or call 911 in an emergency. Dialyzors who want to work are also the ones most likely to be able to handle independent home HD. Some physicians have agreed on a case-by-case basis to allow stable independent people who will follow their prescriptions, recognize and report symptoms, and agree to ask for help when needed to do home HD without a partner. Dialyzors can use a cell phone if they need help, or get a "Life Alert" type safety system to call for help with a single push of a button.

Paying for a Home Partner When Required

Some clinics offer staff-assisted home dialysis (SAHD): the clinic provides trained and competency-tested staff to do dialysis in the home. In most cases, those who receive SAHD have cash or insurance other than Medicare that covers this service. Medicare covers the home dialysis equipment, supplies, and support services, but not a home helper. Home dialysis improves a dialyzor's work chances, and working improves the chances that a dialyzor will be covered by an employer health plan.

Using Work Incentives to Work

Social Security disability checks (SSI or SSDI) are about 1/3 of what patients made from working. Yet, those who want to work may fear losing a guaranteed (but low) income and not know about Social Security work incentive programs.² One program, "impairment related work expenses (IRWE)," can even help those who need to pay a home helper! Under IRWE, out-of-pocket costs to treat an "impairment" (e.g., a home partner) can be used to offset earned income. They must show receipts to Social Security for the month that they earned income. SSA will deduct allowed expenses from countable income and then decide if the person performed "substantial gainful activity". If not, the home dialyzor can pay a care partner and other allowed out-of-pocket costs and still get an SSI or SSDI check. This is only one of the work incentive programs that Social Security offers to help those with disabilities work, including those on dialysis.

Offering home dialysis options at your clinic to those who want to work, or referring to a nearby clinic, can improve dialyzors' satisfaction and quality of life, provide valued employees to area businesses, enhance a clinic's payer mix, and increase the number of dialyzors who pay taxes and support our economy. It's a win-win all around.

References

1. Centers for Medicare & Medicaid Services, End Stage Renal Disease Network Organization Program 2011 Summary Annual Report. Baltimore, MD: CMS; 2012. http://www.esrdncc.org/index/cms-filesystem-action/resources/SAR2011_website_posting.pdf
2. Social Security Administration, The Red Book: A Guide to Work Incentives, http://www.socialsecurity.gov/redbook/index.html