Expert: Cindy Keith, RN, BS, Certified Dementia Practitioner - 2/9/2012

Question
Hi,

My dad is 87 years old and I'm not sure what to do. He is at stage 5 of his kidney failure. It looks like he should be starting dialysis. Some days my dad will say he wants the treatment and others he does not even want to see the Dr cause he wants to stay home. Is there anything to recommend to try to get him to start the dialysis. I don't think I can force him to do it. Are special treatments for dementia patients with kidney failure? I was looking for nursing home that do it in house but can't find any. Any advise would be great.

Thanks

Answer
Hello Ana:
I've changed the status of this question to "public" because I believe there are other families out there who would benefit greatly from the answer--I hope you don't mind.  
When an elder has dementia, any kind of treatment will become a challenge because they can no longer understand the reasons behind them.  My advice would be to NOT ask him if he's ready or wanting to go to dialysis.  Simply get him up and ready and arrive at the appointed time.  If he asks where he's going you can tell him it's for his "treatment appointment so you will feel much better," or something of the sort.  If he says he doesn't want to go, tell him it's already paid for and they charge extra if you don't show up.  By not getting his dialysis regularly, he will quickly build up toxins in his blood and he will be more confused and ill and could slip into a coma and die sooner.  
I did actually speak at a nursing home in the Pittsburgh area once that had in-home dialysis performed, but I'm not sure if they exist elsewhere.  You would be able to find out by calling all the dialysis companies in your area and asking them if they go to facilities, and if so, where are they located.  
Be aware that most nursing homes do have transportation to/from dialysis units, so even if they don't have in-home dialysis, they will transport for treatments. So, if he's at the point in his dementia where he requires more care than you can handle, you can safely admit him to a nursing home and he can still access the dialysis.     
I wish you luck in your search for answers for your dad.