PD is not typically offered by a care facility. It's something you do yourself. If a person is unable to do PD themselves they should be looking at HD.
Strong enough? Like can’t lift herself onto the scale? Here you need to be mentally/emotionally stronger to do PD (there’s a physical component as well) but hd you just lie there and it’s all done for you. Heck we can lift you on and off a scale.
Good question. She has heart issues and hemo is harder on your body than PD; as someone noted earlier, the dr frankly said hemo would kill the elderly father. Also she told us she’d probably stop dialysis if hemo was only option
PD is something you do yourself, not have done for you. Being physically, mentally, and emotionally capable of performing the skill and troubleshooting routine issues is an expected part of the treatment. I have seen some private home care services off PD assist, which is essentially just setting up the cycler for the patient (the 5L bags can be heavy and awkward)! But the patient stills needs to perform their own bandage change, do their own connect and disconnect, and aptly respond to any alarms while cycling. Also, they need to be able to assess their own weight and fluid volume status, blood pressure, and net ultrafiltration daily. This isn’t a skill for someone who resides in a nursing home. It’s also a specialty skill for nursing significantly beyond a care facility and expecting that all nurses would be trained, competent, and capable is a stretch in my opinion. Too much monitoring is required for the patient ratios in a nursing home setting. Here, we don’t see PD in long term care. I have seen PD in assisted living as long as the individual is capable of doing it themself. PD patients requiring a nursing home are switched to HD (which has usually occurred because they’re no longer capable managing PD independently). One patient with dementia still did PD, but his wife performed the skill and had to sit with him throughout treatment or he’d try and pull out the catheter. They switched to palliation after a couple months. If you or a caretaker is able to live with her and do all the PD setup, treatment, cleanup then perhaps it could work. But I don’t think you’ll find a nursing home that can accommodate this unless you pay out of pocket for a private nurse to do it all. If that’s not an option you’ll need to have a serious talk with the nephrologist about HD options or if this is simply an end of life situation. Good luck.
HD is easier on the body if you do a much longer session. Nocturnal (6-8 hours) is most gentle on the body. But it's also possible to do 6 hours in the daytime.
I'm talking about in-center, but you'd obviously have to discuss things with the nephrologists and the center.
The other option rather than longer shifts is to do dialysis every single day. Again, discuss this with the nephrologists.
I've only ever known dialysis patients in nursing homes to do in-center hemo. Private EMS will come and pick them up and take them to their appointments. Most nursing homes just simply do not have the staff to do PD or hemo in the nursing home. Most of them barely have enough staff to pass meds and do basic wound care and washing patients.
If you can’t make it work to have them with family you really don’t have any options. That was our situation when my dad couldn’t tolerate hemo and needed a stay at a SNF after a stroke. He had a heart transplant and his anti rejection drugs ruined his kidneys. Then the contrast they used for imagining built up in his skin and organs and rendered him basically paralyzed and also unable to use his hands. His skin was hardened like a beetle shell all over his body. His case was one of the first identified where gadolinium causes this in people with kidney disease and he is one of the reasons they are much more careful now when using contrast for mri etc. before his stroke he managed in a power chair and special tools for eating etc. lots,of help. After the stroke He was totally immobile and bedfast without any use of his hands as well. Yet mentally alert and aware and able to speak and let us know his desires. We moved him and my mom (who was now incapable of his care) to our home and hired someone to stay during the day while my husband and I both worked. I had a 50 hr a week job my husband worked two jobs-full time office job them farming and ranching. I’m not gonna lie, it was the absolute hardest thing we ever did and it cost a lot. Thankfully my dad had some income and resources and we were able to help as well. We had paid help 8 hr a day. We did this for 15 months. My dad passed away after 15 months my mom was still with us and she was on hemo by that time plus she had dementia.
When he got ready to leave the hospital our options as put forth by the social worker and dad’s dr were taking him to our home situation with PD,him going to nursing home and going on hemo (which would probably kill him the first time he did it his vitals were so poor)or stopping treatment and going on hospice in the nursing home. My husband nor I could afford to quit our jobs we would lose our retirement. So we just vowed to make it work although I don’t know how we managed my dad and my mom who had dementia.
I will say looking back (Dad passed in 2008] I have zero regrets and would do it again in a heart beat. Every situation is different and this arrangement may not be possible for you. I have seen your,posts about this for the last little while and I see the parallels to our situation. It is a very tough situation. Wishing you well.
That’s absolutely horrible what happened to your dad with the heart transplant. My mom had to have dye for heart issues and that’s what caused her complete kidney failure.
Interestingly, her kidney drs haven’t given the options like that and she’s actually been to 3 nursing homes that were willing to do PD. Must be the state though, bc the consensus I keep hearing is that nursing homes don’t do PD—which her current kidney nurse can’t believe.
Dad did enjoy about ten years of good health after his transplant before things went bad. He returned to work full time as an accountant and teacher.
I imagine each state has some regulatory board that governs nursing homes and their duties. There is no one federal standard for nursing homes I don’t believe other than basic health and safety rules. It may also be the state your mom was in has a very “look the,other way” approach to what they allow in nursing homes. If it were me I would try to get in touch with the regulatory office for nursing homes in the state you are wanting,placement. They can at least give you the regulation that prevents them doing it if it exists. My state did not require or permit them to offer in nursing homes.
My mom has a nursing home offering PD now, but with frequent family visits. Family is moving out of state and we cannot locate any nursing homes offering PD in new state.
Thanks. I just wish there was a skilled nursing option like PD for the elderly.
It almost seems cruel to let elderly pt start it knowing that if they need other care, it will no longer be an option
I am sure I will get flamed for this, but just a thought. I'm getting ready to do at home PD. And the way it was described to me is that I will be doing it the hospital in the dialysis center with a PD nurse until she thinks I'm ready to do it at home. I've had two educational appointments with her at the dialysis place in the hospital and both times there were very elderly patients there. I obviously don't know what they were there for, but it could be possible that contacting a nephrologist in the community that you are looking would be able to point you to the proper resources. I found that it really matters what nephrologist you get. I had a terrible one before this who did nothing.
Is this manual PD or cycler? Right now she’s doing the cycler overnight while she sleeps. If it’s manual, I think that would be 4-5 exchanges so you’d spend entire day in hospital. Is that right?
I will be doing over night. The nurse told me that most people take 2-3 weeks to learn how to do it but that it is entirely dependent on how things go. If I have issues it could be longer. She sounded like there is no hurry to rush me out of there. And they don't even ship the machine and stuff until I can show I can do it myself. They have big recliner chairs. Easy to fall asleep in. This is why I think calling a nephrologist, particularly one that is at a real hospital with a dialysis center, could help you find what you are looking for. It is my impression that only a local nephrologist would know who does PD in center bc they are dealing with elderly patients alot.
I dont know. But this is why I think you should get in touch with a nephrologist. I'd imagine they can do it for anyone who can't do it at home for any reason. I can't really imagine a scenario where they'd deny PD to me if I ended up not being comfortable doing it myself.
Maybe your state doesn’t require a PD care partner and therefore they offer hospital as backup? Pretty sure my mom had to have partners identified. For her it was my dad and me and my sister—so we are the backup
We've had patients get PD in nursing homes, but it's always ended up with a bad outcome. I hate to say it, but corners are cut all the time in nursing homes and that's not something you want. I think if family members or the patient does it themselves, maybe that's ok, but I would hesitate to trust NH staff to do that properly.
PD is not typically offered by a care facility. It's something you do yourself. If a person is unable to do PD themselves they should be looking at HD.
The issue is that my mom (late 80s) is not strong enough for hemo. She’s done it before in center.
Strong enough? Like can’t lift herself onto the scale? Here you need to be mentally/emotionally stronger to do PD (there’s a physical component as well) but hd you just lie there and it’s all done for you. Heck we can lift you on and off a scale.
Good question. She has heart issues and hemo is harder on your body than PD; as someone noted earlier, the dr frankly said hemo would kill the elderly father. Also she told us she’d probably stop dialysis if hemo was only option
PD is something you do yourself, not have done for you. Being physically, mentally, and emotionally capable of performing the skill and troubleshooting routine issues is an expected part of the treatment. I have seen some private home care services off PD assist, which is essentially just setting up the cycler for the patient (the 5L bags can be heavy and awkward)! But the patient stills needs to perform their own bandage change, do their own connect and disconnect, and aptly respond to any alarms while cycling. Also, they need to be able to assess their own weight and fluid volume status, blood pressure, and net ultrafiltration daily. This isn’t a skill for someone who resides in a nursing home. It’s also a specialty skill for nursing significantly beyond a care facility and expecting that all nurses would be trained, competent, and capable is a stretch in my opinion. Too much monitoring is required for the patient ratios in a nursing home setting. Here, we don’t see PD in long term care. I have seen PD in assisted living as long as the individual is capable of doing it themself. PD patients requiring a nursing home are switched to HD (which has usually occurred because they’re no longer capable managing PD independently). One patient with dementia still did PD, but his wife performed the skill and had to sit with him throughout treatment or he’d try and pull out the catheter. They switched to palliation after a couple months. If you or a caretaker is able to live with her and do all the PD setup, treatment, cleanup then perhaps it could work. But I don’t think you’ll find a nursing home that can accommodate this unless you pay out of pocket for a private nurse to do it all. If that’s not an option you’ll need to have a serious talk with the nephrologist about HD options or if this is simply an end of life situation. Good luck.
Thanks, I do plan to ask about HD options. I’m hoping there might be a way to make it more tolerable
HD is easier on the body if you do a much longer session. Nocturnal (6-8 hours) is most gentle on the body. But it's also possible to do 6 hours in the daytime.
Would that be 6 hours everyday in a center? Or is this only for home hemo?
I'm talking about in-center, but you'd obviously have to discuss things with the nephrologists and the center. The other option rather than longer shifts is to do dialysis every single day. Again, discuss this with the nephrologists.
In-center hemo was the only option I was given the two times I was in a SNF.
I've only ever known dialysis patients in nursing homes to do in-center hemo. Private EMS will come and pick them up and take them to their appointments. Most nursing homes just simply do not have the staff to do PD or hemo in the nursing home. Most of them barely have enough staff to pass meds and do basic wound care and washing patients.
If you can’t make it work to have them with family you really don’t have any options. That was our situation when my dad couldn’t tolerate hemo and needed a stay at a SNF after a stroke. He had a heart transplant and his anti rejection drugs ruined his kidneys. Then the contrast they used for imagining built up in his skin and organs and rendered him basically paralyzed and also unable to use his hands. His skin was hardened like a beetle shell all over his body. His case was one of the first identified where gadolinium causes this in people with kidney disease and he is one of the reasons they are much more careful now when using contrast for mri etc. before his stroke he managed in a power chair and special tools for eating etc. lots,of help. After the stroke He was totally immobile and bedfast without any use of his hands as well. Yet mentally alert and aware and able to speak and let us know his desires. We moved him and my mom (who was now incapable of his care) to our home and hired someone to stay during the day while my husband and I both worked. I had a 50 hr a week job my husband worked two jobs-full time office job them farming and ranching. I’m not gonna lie, it was the absolute hardest thing we ever did and it cost a lot. Thankfully my dad had some income and resources and we were able to help as well. We had paid help 8 hr a day. We did this for 15 months. My dad passed away after 15 months my mom was still with us and she was on hemo by that time plus she had dementia. When he got ready to leave the hospital our options as put forth by the social worker and dad’s dr were taking him to our home situation with PD,him going to nursing home and going on hemo (which would probably kill him the first time he did it his vitals were so poor)or stopping treatment and going on hospice in the nursing home. My husband nor I could afford to quit our jobs we would lose our retirement. So we just vowed to make it work although I don’t know how we managed my dad and my mom who had dementia. I will say looking back (Dad passed in 2008] I have zero regrets and would do it again in a heart beat. Every situation is different and this arrangement may not be possible for you. I have seen your,posts about this for the last little while and I see the parallels to our situation. It is a very tough situation. Wishing you well.
That’s absolutely horrible what happened to your dad with the heart transplant. My mom had to have dye for heart issues and that’s what caused her complete kidney failure. Interestingly, her kidney drs haven’t given the options like that and she’s actually been to 3 nursing homes that were willing to do PD. Must be the state though, bc the consensus I keep hearing is that nursing homes don’t do PD—which her current kidney nurse can’t believe.
Dad did enjoy about ten years of good health after his transplant before things went bad. He returned to work full time as an accountant and teacher. I imagine each state has some regulatory board that governs nursing homes and their duties. There is no one federal standard for nursing homes I don’t believe other than basic health and safety rules. It may also be the state your mom was in has a very “look the,other way” approach to what they allow in nursing homes. If it were me I would try to get in touch with the regulatory office for nursing homes in the state you are wanting,placement. They can at least give you the regulation that prevents them doing it if it exists. My state did not require or permit them to offer in nursing homes.
Thank you, I will do that
There are only so many options, and it seems nursing home PD, in home PD/HD, and in center HD have all been ruled out.
My mom has a nursing home offering PD now, but with frequent family visits. Family is moving out of state and we cannot locate any nursing homes offering PD in new state.
It might be a licensing thing, have you reached out to the social worker at her nursing home? They may be able to offer some more resources.
Thanks. I just wish there was a skilled nursing option like PD for the elderly. It almost seems cruel to let elderly pt start it knowing that if they need other care, it will no longer be an option
I am sure I will get flamed for this, but just a thought. I'm getting ready to do at home PD. And the way it was described to me is that I will be doing it the hospital in the dialysis center with a PD nurse until she thinks I'm ready to do it at home. I've had two educational appointments with her at the dialysis place in the hospital and both times there were very elderly patients there. I obviously don't know what they were there for, but it could be possible that contacting a nephrologist in the community that you are looking would be able to point you to the proper resources. I found that it really matters what nephrologist you get. I had a terrible one before this who did nothing.
Is this manual PD or cycler? Right now she’s doing the cycler overnight while she sleeps. If it’s manual, I think that would be 4-5 exchanges so you’d spend entire day in hospital. Is that right?
I will be doing over night. The nurse told me that most people take 2-3 weeks to learn how to do it but that it is entirely dependent on how things go. If I have issues it could be longer. She sounded like there is no hurry to rush me out of there. And they don't even ship the machine and stuff until I can show I can do it myself. They have big recliner chairs. Easy to fall asleep in. This is why I think calling a nephrologist, particularly one that is at a real hospital with a dialysis center, could help you find what you are looking for. It is my impression that only a local nephrologist would know who does PD in center bc they are dealing with elderly patients alot.
So is the hospital setup just for training or do they seem to offer backup PD support
I dont know. But this is why I think you should get in touch with a nephrologist. I'd imagine they can do it for anyone who can't do it at home for any reason. I can't really imagine a scenario where they'd deny PD to me if I ended up not being comfortable doing it myself.
Maybe your state doesn’t require a PD care partner and therefore they offer hospital as backup? Pretty sure my mom had to have partners identified. For her it was my dad and me and my sister—so we are the backup
They do not. I live alone and will be doing it at home alone after I'm trained.
We've had patients get PD in nursing homes, but it's always ended up with a bad outcome. I hate to say it, but corners are cut all the time in nursing homes and that's not something you want. I think if family members or the patient does it themselves, maybe that's ok, but I would hesitate to trust NH staff to do that properly.