Home help

[cassandra]

Hemodial Int. 2016 Aug 22. doi: 10.1111/hdi.12476. [Epub ahead of print]
Personal Support Worker (PSW)-supported home hemodialysis: A paradigm shift.
Pierratos A1,2,3, Tremblay M1,2, Kandasamy G2, Woodward G2,4, Blake P2,5, Graham J2,6, Hebert M2, Harvey R2.

Abstract

Introduction 
Despite improving clinical outcomes associated with the use of home hemodialysis (HD), its utilization is low in most countries. The inability or unwillingness of patients and their families to participate in their own treatment is one of the most important barriers to the adoption of home HD. Methods We hypothesized that paid helper-delivered home HD supported by public funds would be successful and welcomed by patients and be delivered at an affordable cost. We conducted a pilot project to dialyze six patients at home using Personal Support Workers (PSW) and resolve regulatory, organizational and financial constraints. Findings We provided publically-funded PSW-supported home HD to six patients. We describe the administrative structure of the pilot project allowing scalability and turnkey operation in the province of Ontario. Regulatory and insurance concerns were resolved and patients and staff were enthusiastic. The projected total dialysis cost, when economies of scale are met, are expected to be lower than the cost of in-center HD. Discussion A second phase of the project is currently under way including 8 hospitals and 67 patients. If equally successful, it may have significant implications for the delivery of care for End Stage Renal Disease in Ontario and similar jurisdictions. It promises to increase the utilization of home dialysis possibly at a lower cost than in-center HD. This would be particularly important in providing dialysis in underserviced and geographically hard to access areas.

© 2016 The Authors Hemodialysis International published by Wiley Periodicals, Inc. on behalf of International Society for Hemodialysis.

[Simon Dog]

It would be a nice trick if they really can pay for a helper and come in at lower than in-center cost. 

The only way I could imagine that happening would be if the helper did setup and canulation, and the patient or a family member did the disconnect.

[cassandra]

I seem to remember that 30 years ago in The Netherlands they had one helper connect several patients, and than disconnected them (in the same order I would think if those people did the same length session) Set up should be poss for patient, or family.

I think it would be a better idea to make the time, and take the effort to help people to learn to cannulate themselves. Some people need more help with that. Some people have been so institutionalised that selfcare and especially self cannulation seems impossible for example.

[kristina]

Theoretically it sounds very plausible and forward-thinking...
... Here in the UK there were many helpers employed by the government (NHS) to help the sick, elderly and frail, but unfortunately this wonderful idea was soon getting bad write-ups when it came out that many elderly people were depleted of their assets at home (cash and jewellery, money in saving books, money in bank accounts etc.) by the "wrong lot" who had applied for these jobs especially for the aforementioned purpose ... since then many elderly or sick people who are entitled for regular home-help would not even think about applying for it ...

[iolaire]

In Montreal the "helpers" at the hospital center were all nurses.  I could see CAN saving money over center if they use this to move to the lower skill/pay technician model and send lower priced techs to the home replacing higher costs nurses in a hospital setting with all the hospital overhead.  I would guess their "center" costs are very high if all the centers are in hospitals. 

FYI: So far Montreal CAN was the most expensive foreign city for dialyses at about $750 USD/session, with Brussels coming in at about $550 USD/session.  The lowest was a NephroCare center in a hospital in Lisbon Portugal at 117.5/euro or about $132 USD.

[Charlie B53]

It is very difficult to compare costs of different facilities.  Bean counters have a lot to do with how the numbers come together. Juggling the numbers to give the outcome that someone expects.  Facility costs can be 'scheduled' many different ways.   Drug companies are very good at this to justify outragious prices on many medications just to improve the profit margin.

I would be curious to see how all the numbers compare.  To see the actual spread sheets for each of the facilities so to compare many of the individual charges used to arrive at their totals.   THAT would show something.