by Kayla Sloan
Imagine walking in the shoes of someone who needs dialysis treatment. You have a set schedule for the week. Perhaps it is MWF from 7 a.m. – 11 a.m. You are dropped off at the clinic to begin your day with treatment. First you must be weighed, have your blood pressure and temperature taken, and then you are escorted to a reclining chair where you will remain for the next four hours while your blood is taken out of your body and circulated through a machine to be filtered and cleaned. Typically, there is a TV and wi-fi available to help pass the time. Like most medical offices you can recall since your childhood, it is probably quite chilly, and the treatment process only makes you feel colder. It is a harsh reality, but with any medical condition, treatment is not always comfortable.
However, there is one option that can help give a dialysis patient more freedom and hopefully a better quality of life – home dialysis. With in-center hemodialysis, the patient is tethered to the provided hours and locations of physical dialysis centers. They will be given treatment among other dialysis patients and medical professionals, which to some may be the best option and provide some form of companionship during the process. However, for others, dialyzing in the privacy and comfort of their own home may provide the best course of treatment.
With changes in Medicare reimbursement within the last decade, home dialysis has become more of a priority to providers giving patients more treatment options. In order to be on a full-time home dialyzing program, the patient must first go through a training period in which a team of nephrologists, nurses, dietitians, social workers, and other medical professionals provide a detailed care program and instruction to the individual. Design standards for hemodialysis centers and home training facilities differ due to the difference in their treatment locations. It is still important to provide a level of comfort for the patient no matter what the facility type, but while a home training facility still requires most of the same staff and patient support areas, the designer must keep in mind that these patients are being trained to dialyze at home. For this reason, you want the facility to feel as close to home as possible. Your average American does not have an automatic, touchless faucet in their home, so why would you train them with one?
A typical home training room encompasses between 120 – 150 square feet and contains the necessary plumbing requirements and training aids. Most home dialysis machines require a simple water hookup and drain. These can be accomplished by a sink faucet or even a washer hookup for water supply and a shower for drainage. Within the room, there is a clean handwash sink and a dirty sink for disposal of liquids such as bodily fluids, and in some instances a washer box is provided as an alternative. These fixtures are accessible for the patients to use during training. Cabinetry is provided for storage of supplies. The patient will have a recliner similar or identical to those provided in a hemodialysis center and will also have access to a TV and wi-fi. The TV serves a dual purpose of patient use and as a means for staff to show training videos and visuals.
The aesthetics of the room should be warm and inviting while also non-distracting. You want to give the patient confidence in their choice to home dialyze and provide them a calming and private space to learn and absorb all the information given to them. This thought can influence all levels of design from the minute detail of providing a sliding mount for the TV so it is easily seen while reclined during treatment or upright during instruction, to utilizing a specific HVAC supply grille to divert air horizontally rather than vertically down onto the patient, up to the broad decision of providing a window in every treatment room.
Studies have shown that clinical outcomes for patients utilizing home dialysis are as good as or better than those for patients treated conventionally at a hemodialysis center (1). At this point, it’s only practical to keep pushing this method of treatment forward.
1. Rivara MB, Mehrotra R. The changing landscape of home dialysis in the United States. Curr Opin Nephrol Hypertens. 2014;23(6):586–591