Dialysis from the Comfort of Home: Letisha’s Story

Home dialysis provided ‘better outcomes, a better lifestyle,’ says Brooklyn woman who continued working through treatment  

Letisha Wadsworth remembers when her doctor said her bloodwork indicated she’d need to start kidney dialysis in six months. 

Instead, Wadsworth, now 74, has been able to dialyze from the comfort of her home. Her husband helps connect her to a machine to cleanse her blood of toxins for five hours most days of the week. During that time, she eats dinner, watches TV or plays Scrabble with her family. Sometimes friends come to visit. She was also able to continue working for four years as the director of childcare services for a social service agency before she retired. 

“I think it is the ideal,” Wadsworth said of being able to dialyze at home. “I think you have better outcomes, a better lifestyle. It doesn’t become the major focus of your life.”

It’s experiences like Wadsworth’s that motivated the Center for Medicare & Medicaid Innovation (CMS Innovation Center) to make home dialysis more readily available to patients through its pilot programs. 

Wadsworth receives her care at the Rogosin Institute, which participated in the CMS Innovation Center’s Comprehensive End-Stage Renal Disease Care Model, a pilot program that ran from 2015 to 2021 and promoted in-home dialysis to give patients more flexibility and improve health outcomes.

The Innovation Center has since launched two more programs to help kidney patients. The End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model encourages home dialysis and improving patients’ overall care and quality of life. The Kidney Care Choices model aims to improve care and delay the onset of dialysis. 

Home dialysis has support among health care providers and patients as preferable alternatives to in-center hemodialysis, but have been used less than in other developed nations. Home dialysis is not as lucrative compared to dialysis providers in the Medicare fee-for-service payment system, where providers are compensated based on the number of services offered and patients they see. Though patients must be trained on how to deliver home dialysis, after that, they require fewer visits than those who must visit a dialysis center multiple times a week. Home dialysis is aligned with value-based care, which that focuses on performance, quality and the patient's experience of care.

Wadsworth’s nephrologist, Dr. Frank Liu, said home dialysis has been a boon to her and other kidney failure patients who are unable to get a transplant or must rely on dialysis before they can receive one. 

Most patients, he said, are “really worried about what their life if going to be like,” he said. 

Dialysis at home can give them greater flexibility, even allowing them to do it more frequently than the typical three sessions per week at a center; it’s less taxing for patients, allowing them to keep up with regular activities, he said. 

But more importantly, Dr. Liu explained that patients who dialyze at home have better health outcomes. 

“Medical outcome-wise, it is probably the best,” he said. 

Wadsworth has worked as a volunteer, counseling other kidney failure patients. She said she recommends at-home dialysis.

“I don’t have the schedule issues, and a lot of issues people face. I don’t, frankly, feel as tired,” she said. 

For her, the choice was clear: “Would you rather go home and see your people or go to a dialysis center?”