In-Home Dialysis Care Explained: Types, Costs, & Support

Kidney dialysis is life-saving, but it's also life-altering.

Multiple trips to the clinic each week can take over your schedule, leaving you exhausted and at risk of missing sessions.

Today, more patients are turning to at-home dialysis to ease this burden.

Home dialysis use in the U.S. is at its highest point in a decade. About 1 in 7 people on dialysis now do their treatments at home, and the number of people on home hemodialysis nearly doubled between 2013 and 2023.

You also don’t have to manage treatments on your own. Your clinic trains you and a Care Partner to run each session together. Care partners can be a family member, friend or an in-home caregiver who attends training with you at your clinic.

This guide covers the different types of home dialysis, what to expect during treatments, home dialysis costs, how a Helper can support you, and how to decide if it’s right for you.

What is in-home dialysis care?

At-home dialysis means you receive treatments at home instead of traveling to a clinic multiple times a week.

The treatment itself is the same. A smaller, more portable version of the dialysis machine filters waste and excess fluid from your blood, then returns the cleaned blood to your body. You’ll usually need a Care Partner to help with treatments, either a family member or a professional caregiver.

Here are a few benefits of bringing dialysis treatments home.

Time saved

Dialysis treatments can fill up your entire day, especially when you have to travel to a clinic.

In-center hemodialysis usually means three trips a week, plus time in the waiting room before and after each session. Getting there can be a challenge. People with longer travel times to their clinic and those without their own car or a reliable ride are more likely to miss treatments.

In-home dialysis cuts out transportation and waiting room time completely, saving you hours each week.

Increased privacy

Having treatments done inside a clinic doesn’t come with much privacy. There are nurses and dialysis techs administering and monitoring your sessions.

Home treatments happen in your own space, on your schedule, with only the people you choose around you.

Enhanced safety for medically complex patients

Traveling to a clinic three times per week is hard enough on patients with lower medical needs, but can take a serious toll on those with more health issues such as diabetes or heart conditions.

Home dialysis can ease the stress of these patients and lower the fall risk that comes with traveling to clinics.

Reduced hospitalization rates

Skipping a treatment lets fluid and waste build up in your body. Missed treatments can lead to fluid overload, which can cause shortness of breath and may cause a trip to the emergency room.

Home treatments are much more convenient and less likely to keep you from your next session.

Is home dialysis right for you? Eligibility & home setup

Home dialysis isn’t only for the healthiest patients. Your home dialysis options depend on a combination of your health, your home setup, and the support you have available.

Here's what your care team will review before clearing you for training.

Your health, abilities and support

Your care team looks at your full health picture, along with your ability to handle treatment safely, either on your own or with a Care Partner.

You may be a strong candidate if:

• Your care team confirms your condition is manageable outside a clinical setting
• You or your Care Partner can see clearly and use your hands well enough to handle equipment
• You or your Care Partner can stay organized and follow step-by-step instructions
• You or your Care Partner feel confident keeping schedules and records

If this sounds like you, your team will likely approve you to begin training.

Your Home Environment

The space where you do treatments will need to meet some basic requirements.

Most people need:

• A quiet, clean area set aside for dialysis
• Steady electricity and running water
• Storage space for several weeks of supplies
• A plan in case of power or water outages

Having these basics in place helps ensure your treatments are consistent and safe.

Infection Prevention Basics

Dialysis works only if infection control is taken seriously. During training, your clinic will show you and your Care Partner how to:

• Wash hands carefully before every step
• Keep surfaces and equipment clean
• Watch for early signs of infection
• Use sterile technique exactly as taught

It might feel strict at first, but over time these steps become second nature and protect your health.

Quick Checklist

Before training, ask yourself:

• Is there enough space and storage at home?
• Do I have reliable power and water?
• Am I willing to follow infection-control steps every time?
• Do I have a loved one or professional caregiver who can be my Care Partner for treatments?

If you can answer “yes” to most of these, you’re in a strong position to succeed with home dialysis.

What does in-home kidney dialysis cost?

In-home dialysis costs depend on your insurance. The medical side of treatment is usually covered, but paid help at home will likely be out of pocket.

Here’s how the costs break down:

• Medical care and training: Original Medicare, Part B covers 80% of home dialysis costs after you meet your yearly deductible, including your machine, supplies, and training. You or a supplemental plan pay the other 20%. Private insurance and Medicare Advantage plans set their own deductibles and co-pays.
• Helpers for treatments: Medicare doesn’t cover paid aides for home dialysis, so you’ll likely pay a Helper out of pocket. Rates for Helpers on Herewith cost around $20-$30 per hour.
• In-home care: Help outside of treatments, like rides, personal care, cooking, or housekeeping, is also paid out of pocket in most cases. You can also book an in-home caregiver for these needs through Herewith.
• Transportation: Coverage for rides to clinic visits depends on your plan and the type of transport you use.
• Home setup: Most homes only need minor adjustments. Adding storage or backup power can raise costs.

Keep in mind, paying for support at home also protects your health. Missed treatments can lead to a trip to the emergency room or a hospital stay which can get expensive. A Helper who keeps you on your treatment schedule helps you avoid those setbacks.

Your dialysis clinic is the best place to start. They can tell you what your plan covers and where you’ll need to budget for extra support.

Understanding your home dialysis options

There are two main types of home dialysis, each working differently to clean your blood and remove excess fluid.

Your medical team will help you choose the best option based on your health, lifestyle, and personal preferences.

When comparing home dialysis vs. in-center dialysis, one of the biggest differences is where treatments take place and how much flexibility you have in your schedule.

Let’s walk through how each type works and what to expect.

Home Hemodialysis (HHD)

Home hemodialysis uses a machine to filter your blood outside your body. Blood flows through tubes to a dialyzer (artificial kidney) that removes waste and extra fluid, then returns clean blood to your body.

This treatment needs vascular access, such as a fistula, graft, or catheter, to let blood flow in and out during treatment.

The process is similar to clinic hemodialysis, but the equipment is built for home use. Newer machines plug into standard household outlets, though some homes need minor plumbing or wiring changes.

Treatment schedules for HHD are flexible:

• Short daily sessions: 2-3 hours, five to six times per week
• Nocturnal treatments: 6-8 hours while you sleep, usually every other night
• Standard schedule: 3-4 hours, three times per week (like clinic dialysis)

Home Peritoneal Dialysis (PD)

Peritoneal dialysis uses the lining inside your abdomen (peritoneal membrane) as a natural filter.

A catheter placed in your belly allows dialysis fluid to flow in and out, cleaning your blood without any needles during treatment.

There are two main approaches:

• CAPD (Continuous Ambulatory Peritoneal Dialysis): You manually exchange fluid 3-4 times during the day
• APD (Automated Peritoneal Dialysis): A machine does exchanges automatically while you sleep

PD must be done daily to stay effective. Many people like this option because it’s needle-free and can be done almost anywhere that’s clean and private.

Many people lean on a family member for help with home dialysis, but family can’t always be there. A trained Helper can step into that role.

What Helpers and care partners do at home

Support at home can look different depending on the type of dialysis, your level of independence, and what your home situation is like.

Clinic-trained Care Partners

Most home hemodialysis programs require a Care Partner. This is because the treatment itself isn’t easy. Most patients need to insert two needles into a blood vessel in the arm before each session.

Your Care Partner may be a family member, friend, or Helper who completes any training required by your dialysis clinic before assisting with treatment.

A Care Partner may:

• Assist with treatment setup under nurse instruction
• Help monitor the machine during sessions
• Keep records as directed by the clinic
• Respond to issues using the plan you and your team create

In some cases, Herewith can help coordinate training between your Helper and your clinic. You and your clinic are responsible for making sure any required training is completed before a Helper assists with treatment.

Helpers booked through Herewith

In addition to finding Helpers to be your Care Partner on Herewith, you can also book Helpers for more general care.

Helpers can support your daily routine around dialysis. They focus on the tasks that make treatment days easier, such as:

• Driving you to and from clinic visits or other appointments
• Organizing your treatment space and supplies under your direction
• Preparing meals that fit your diet plan
• Noticing changes in how you feel and sharing updates with your family or clinic
• Assisting with transfers or mobility
• Offering companionship during or after treatment

Helpers booked for general care don’t perform sterile procedures or make medical decisions. Their role is to keep your home environment safe, comfortable, and well organized, and provide personal caregiving services if needed.

Knowing these boundaries makes it easier to decide what kind of support you need at home.

What to expect during home dialysis training

You won’t be on your own when you start home dialysis. Your clinic will guide you step by step until you feel confident managing treatments at home with your chosen Care Partner.

Training usually lasts a few weeks to a few months, depending on the type of dialysis and how quickly you and your Care Partner feel ready.

During this time, you’ll work closely with dialysis nurses and technicians at your clinic.

You’ll learn:

• How to set up, run, and care for your dialysis equipment
• Safety checks and what to do if something feels off
• Infection-prevention steps to keep your access site clean
• Simple record keeping, like logging treatment times and fluid removal
• Emergency protocols and who to call if you need help

Your clinic doesn’t disappear once you’re home. Your care team stays involved through regular check-ups and is there to help if something comes up with your equipment or your health.

Most programs ask both you and a Care Partner to complete training together, so you always have backup during treatments. If you have Medicare, Part B covers training for both of you.

Making the right choice for home dialysis

Deciding on home dialysis is a big step. Your medical team will help you decide if it's safe, but the choice also depends on what feels realistic for you.

Here are a few things to weigh as you make your decision:

• Your comfort level: Are you ready to take on the responsibility of managing treatments at home?
• Your home setup: Do you have enough space, reliable utilities, and a clean area for treatments?
• Your support system: Is someone available to help during treatments, whether that's a family member, friend, or trained Helper?
• Your lifestyle goals: Will flexible scheduling help you keep working, traveling, or staying active with your family?
• Your care team's guidance: Has your care team confirmed home dialysis is a safe option for you, with the right support in place?

Taking time to think through these questions will help you decide if home dialysis is the right fit for your health and your life.

If you’re looking for a Care Partner or Helper to assist you for home dialysis, you can explore Helper profiles on Herewith or call us at 415-506-9776.

Families also ask:

Is it better to do dialysis at home?

Home dialysis can give you more flexibility, better blood pressure control, fewer diet limits, and higher energy compared to clinic treatments. It isn’t right for everyone, though. Your medical team will help you decide if it fits your health, home setup, and support system.

Will Medicare pay for a Care Partner to help with home dialysis?

Medicare covers most of the medical side of dialysis, including your machine, supplies, and training for both you and your Care Partner. It doesn’t cover paid aides for home dialysis, so a Helper is usually paid out of pocket. Talk to your clinic to see if they have a partnership with Herewith and check on cost and insurance coverage.

How often do you do dialysis at home?

It depends on the type of dialysis you use. Home hemodialysis can be done three times per week, in shorter daily sessions five to six times per week, or overnight every other night. Peritoneal dialysis must be done every day to stay effective. Your nephrologist will recommend the best schedule for your needs.

What’s the difference between home dialysis and in-center dialysis?

The main difference is flexibility. In-center dialysis happens on a fixed schedule three times a week at the clinic. Home dialysis lets you decide when treatments happen in your own space. Both clean your blood effectively, but home dialysis often allows more frequent sessions, which can support better overall health.

How much does home hemodialysis cost per month?

Medicare Part B typically covers 80% of medical costs, including your machine, supplies, and training. The rest is billed to you or a supplemental plan.

Helpers on Herewith usually charge $20 to $30 per hour, paid out of pocket. Three-hour sessions three times a week add up to about $800 to $1,200 a month. But check with your clinic to see if we partner with them for supplemental coverage.