Creatively improving the provision of dialysis: the Hana, Maui model of communial home hemo

By Bill Peckham

In March of last year I wrote about the effort to provide dialysis in the remote community of Hana Maui. On Saturday The Maui News posted an article, Hana home dialysis sets a Feb. 20 start announcing the launch of an innovative home hemodialysis program. The innovative feature of this program is the home hemodialysis will be provided in a neutral location, a home donated for the use of all the dialyzors in the community (currently 2 but the number ebbs and flows, 5 additional people have been identified with CKD).

The Maui News article announces that a building, formerly a residence for the community doctor, has been turned over to the community for the use of as a communal home hemodialysis center. This is a final step; the most critical step was taken in October when the Centers for Medicare and Medicaid Services (CMS) approved a first-of-its kind arrangement. The dialyzors in Hana will go to a local home, where their own machine (provided by Liberty Dialysis) will be set up by trained community volunteers (trained by Liberty Dialysis) and these volunteers will serve as dialysis helpers. You can read the letter from CMS Regional Administrator Deborah Romero authorizing Liberty dialysis to provide communal home dialysis, it's exhibit C on page 8 of this pdf.

I think this could be a model for care in other rural communities without enough dialyzors to support a small unit. Beyond economics an advantage of co-locating home dialysis machines would be to address some of the reasons people are reluctant to choose home hemodialysis. A dialysis co-op would preserve the social atmosphere of going through dialysis incenter, the space issue related to storing home hemo supplies and equipment would no longer be an issue and family members would not have to be be exposed to the treatment or have to provide support so they could continue to avoid dealing with their loved one's condition. Kudos to CMS and Liberty Dialysis for supporting this innovative program.

The group that has been formed to provide support and advocate for all this is called Hui Laulima O Hana. I'll be interested in following the co-op's progress.

Comments

[Lehua Cosma]

Aloha Bill,
On March 25, 2009 dialysis patients living in the remote community of Hana, received their first treatment at their new communal home, named "Hale Pomaika'i, which signifies, "The blessed Home or House". Each patient is professionally assisted with their own Health Aide, staffed by the non profit organization "Hui Laulima O Hana". The outcome is so positive, as patients no longer need to travel great distance, and the quality of life is tremendously returning. Hui Laulima O Hana, continues to rely on fundraising, donations, and grants to help compensate dialysis health aides, and pay for its utilities, and maintenance of the home. A thrift store adjacent the dialysis home, has opened in October of this year, where proceeds help to fund the unfunded services provided by Hui Laulima O Hana. The thrift shop is successful through the many help of volunteers, and the generous donation of useable and saleable items, almost anything, donors not only help HLOH to raise significant funds, but also help to provide much needed items to be recycled to those who rely on the thrift store to meet the needs of their families. We encourage many to visit our website: www.huilaulima.org and make a contribution to the first-of-its-kind communal home dialysis in Hana, Maui Hawaii... God Bless and Thank You!

[Bill Peckham]

Thanks for the update Lehua. I know you've worked long and hard to make this a reality. I just looked back at the old Dialysis_Support list and your first post in June 2004 when you spoke about working to get local access to dialysis.

Great Job!