I've got a question

[apetty]

If you get trained at a home program, then what if later on down the road you need or want to switch providers? Like Davita to Fresineius or to an independent provider?

[Charlie B53]

That is a very good question.   I have wondered the same thing.   I imagine as long as both places use the same equipment and supplies from the same manufacture it may only involve shuffling a lot of paper.  At worst it can be returning all equipment and receiving new from the new Clinic.

Consumable supplies are another story.  As with my cases of PD solution, once delivered to the house none may be returned.  Period.

If the 'new' equipment is different the fittings are NOT compatible.  My current supplies cannot be used unless I come across a very special adapter fitting.   I have heard that some Clinics have access to such a fitting to use for transient patients.  I haven't heard if it is available for patient use.

People move, vacations, life, whatever.  Clinics see this and handle it.    Not a big problem.    It does make it much easier with adequate warning.   Notification that you will need to come in there with at the very least a week notice or more to give them time to ensure they will have anything and everything you will need for proper care and treatment.   Common courtesy goes a long way to prevent future problems.

[PrimeTimer]

I believe if you're on a home dialysis program and move, you'd still have to be anchored so to speak to a clinic that offers and supports the modality of your choice. For instance, not all Fresenius clinics offer home dialysis programs. My husband does home-hemo and uses Fresenius. We have a Fresenius clinic within 3 miles of our home but that particular clinic doesn't have nurses who are trained and can be on-call for home dialysis patients. So, he uses a Fresenius clinic that is a little farther away. If we move to another city we will either have to find another Fresenius that supports his home program or else switch to another provider. Another thing to consider would be medical insurance (if you have private pay) and coverage for the modality and clinic you choose. Good luck to you. 

[Fabkiwi06]

Not sure how it works for a permanent move, but I had an extended visit "back home" to Northern Michigan, and there is only ONE clinic in 80 miles, and it's a Hemo clinic, not a Home Dialysis clinic. I know my clinic down here did get in touch with them to ensure that I could get in touch for any emergency situations. I was given an extra transfer set adapter to keep up there "just in case".

I assume if you were moving, your clinic would work with you to find a clinic that would work with your setup. I imagine it works a bit like when you go on vacation - but without the return date.

[Simon Dog]

If the 'new' equipment is different the fittings are NOT compatible.  My current supplies cannot be used unless I come across a very special adapter fitting.   I have heard that some Clinics have access to such a fitting to use for transient patients.  I haven't heard if it is available for patient use.

I assume you are talking about PD.   The Fresenis and Baxter connections to the PD gut tube are different.  When I was on PD, they gave me a disposable adapter and case to take with me if I ever was hospitalized in case the hospital was using the Baxer system.

As to switching clinics - You would keep supplies you already have (they are treated as potentially contaminated once in a patient house).   Unless you were with the same company, you would almost certainly return your machine and get one from the new clinic.   You would have to convince the MD at the new clinic to write orders for home treatment, and I expect the home training RN would want to see you do a treatment to make sure (s)he felt comfortable with your skills.

I know here in the Democratic Peoples Republic of Massachusetts all dialysis clinics must either have a home treatment program, or an affiliation with a clinic that offers home service.   See 105 CMR 145.320 and 105 CMR 145.800 - 105 CMR 145.850 for details.   Unfortunately, the CMR is not specific regarding modality, so a clinic might be able to meet the requirement by having a PD program.

[apetty]

Thanks guys.  You mentioned that you would have to convince the MD at the new clinic to let you do home dialysis, and I am talking about both modalities, either or.  I have run into the MD problem several times.  Is it customary for the MD to make a decision about your fitness for a home program without ever meeting or speaking with you?

[Simon Dog]

I don't now how common it is, but I know there are vast differences between MDs.  One of the home hemo patient at the clinic I use is a transferee from another clinic, since the MD at his previous clinic did not think he could do it.  The last I heard, he is doing well, and I still see his initials up on the home care RN's scheduling board.