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 drained and at risk of missing sessions.

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

Herewith COO Veronica Baiz recently sat down with Jerome S. Tanenbaum, MD, PhD, FACP, Chairman and CEO of Sanderling Renal Services, and Gerald Roca, RN, Sanderling's COO, to talk about their home dialysis program.

They shared the benefits of home dialysis and how they’ve been able to extend home treatments to even the most medically complex patients, with promising results.

This guide will cover the different types of home dialysis, what to expect during treatments, home dialysis costs, and how to decide if it's right for you.

What is in-Home dialysis care? (definition + benefits)

In-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 machine filters waste and excess fluid from your blood, then returns the cleaned blood to your body. Usually a Care Partner is needed to help the patient with treatments, either a family member or professional caregiver.

Tanenbaum and Roca shared several benefits patients experience once they make the move home.

Time saved

Dialysis treatments can seem to fill up an entire day for a patient, especially when traveling to a clinic.

“By the time you add the transportation time, the dialysis time sitting in the waiting room, waiting to get on your machine, and then doing all that in reverse, for many patients, that is an eight hour day,” Dr. Tanenbaum explains.

In-home dialysis cuts transportation and waiting room times completely, saving patients hours.

Increased privacy

Having treatments done inside a clinic doesn’t come with much privacy.

“In the dialysis clinic, it's not personalized and it's not private. Having all this done at home, with the assistance of a trained caregiver, would make all the difference in the world to a lot of patients," says Tanenbaum.

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.

"For a patient who is sick to start with and has other comorbid conditions like heart failure, diabetes, pressure, strokes and so forth, that becomes a really challenging day,” says Tanenbaum.

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

Reduced hospitalization rates

Patients are less likely to miss treatment with home dialysis, and missed treatments are a major driver of hospitalizations.

Sanderling experienced these results first hand.

"The hospitalization rate among those patients in our small study a few years ago was 40% less than those same patients when they were coming into the clinic,” says Tanenbaum.

Is Home Dialysis Right for You? Eligibility & Home Setup

For years, home dialysis was considered an option only for the healthiest, most independent patients.

"The conventional wisdom over the years has been that home hemodialysis is only good for someone who is a totally stable patient," says Tanenbaum.

That's changing. Sanderling has placed patients on home dialysis with significant health needs, including some on a ventilator or coping with severe heart failure.

"We've had no incidents at home at all," Tanenbaum says. "The patients have been very stable."

Medical complexity alone doesn't rule out home dialysis. What actually determines whether it's right for you is 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 managing schedules and keeping 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

When these basics are covered, your treatments are smoother and less stressful.

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?

Most of the medical side of dialysis is covered by insurance or Medicare. This usually includes your machine, supplies, and training. Families rarely pay for these pieces out of pocket, but you'll need to check with your insurance about deductibles, co-pays and coverage.

When it comes to home hemodialysis, coverage can also vary by insurance provider. Some dialysis-specific plans do cover the cost of a home dialysis Helper and other home treatment costs, such as equipment set-up.

However, regular in-home care Helpers are typically out of pocket costs. If you need someone to drive you to appointments, provide personal care and support with other conditions, house cleaning, cooking, that can also be arranged through Herewith by searching for in-home care.

Whether or not your insurance covers the cost of in-home treatments, that added expenditure is worth weighing against what it can help you avoid. Missing treatments can lead to fluid buildup, and in some cases, a trip to the emergency room or even a hospital stay.

"That hospitalization can cost them two to three times the cost of the dialysis itself for the whole year," Tanenbaum says.

For many families, consistent support at home ends up paying for itself.

Here's how the costs usually break down:

• Medical care and training: Typically covered by Medicare Part B at 80%, with the rest billed to you or a supplemental plan.
• Supportive Helpers: Paid out of pocket, usually $25–$45 per hour depending on location, experience, and whether the shift is daytime or overnight.
• Transportation: Costs vary if you use a Helper for rides, paratransit, or non-emergency medical transport. Some options are covered by insurance, some are not.
• Home setup: Most homes only need minor adjustments, but families sometimes add storage or backup power, which can increase costs.

Every situation is different. The best place to start is with your dialysis clinic, since they can tell you exactly what's covered and where you may 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.

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 has changed.

"The machines that we use are very portable," says Tanenbaum.

"The one we use in particular most of the time is about 70 pounds, and it can be literally put on a table. I know of companies that are designing a machine that weighs 22 pounds, almost the size of a briefcase.”

Treatment schedules for HDD 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.

Some people opt to have a family member help out with their home dialysis, but that’s not always possible for everyone. Sometimes professional expertise is easier or more convenient.

What Helpers and Care Partners Do at Home

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

Clinic-trained Care Partners

For home hemodialysis, many programs require a Care Partner. "You can do it yourself, but that's not really a good idea," Tanenbaum says. "You need to have a 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 is usually a family member, professional caregiver, or Helper who completes training through your dialysis clinic.

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

A Care Partner plays an important role in supporting your weekly treatments, and their duties are dictated by your clinic's instructions and protocols.

In some cases, Herewith can help coordinate training between your Helper and your clinic, though the responsibility relies with you and your clinic to ensure the training is completed.

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 light 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 do not perform sterile procedures or make medical decisions. Their role is to keep your home environment safe, comfortable, and well organized.

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

The training process: What to expect

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.

"The clinic is always there as a backup," Roca says. "If something happens to your equipment or at home, you can always go back and use that as a fallback to continue your treatments."

Most programs ask both you and a Care Partner to complete training together, so you always have backup during treatments.

Outside of treatments, many people choose to bring in additional Helper services for extra support at home. While Helpers don't provide medical support, they can handle personal care tasks, transportation, help around the house, and companionship to support any other care needs and overall wellbeing.

Making the right choice for home dialysis

Deciding on home dialysis is a big step. It changes your daily routine, family life, and long-term health. 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.

For one Sanderling patient, home dialysis improved both his health and quality of life.

He'd been missing treatments and cycling in and out of the hospital before moving to supported home dialysis. "The man is not missing treatments anymore," Roca says. "Hospitalizations have dropped, and he's a happy man."

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. It does not cover Helpers who provide non-medical support, with the exception of some forms of respite care. That kind of help, such as transportation, companionship, or setting up your treatment space, is usually paid out of pocket.

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.

Helper support isn't covered by insurance and usually costs $25 to $45 per hour. For families using a few hours of support several times a week, that typically adds up to $800 to $2,000 or more per month, depending on your location and how much help you need.

What happens if something goes wrong during home dialysis?

Your clinic training will cover exactly what to do in an emergency. Always contact your dialysis team or healthcare provider with any questions or concerns. Having a Care Partner or Helper with you adds another layer of safety if you need someone to help make phone calls or contact an emergency number.