Flexibility to Best Meet Patient Needs: Jacqueline's Story as a care partner

"I became very comfortable with it" says wife of kidney dialysis patient who learned to administer treatment at home

Jacqueline Samuel knew her husband, Connor Samuel, would likely end up on dialysis after doctors indicated his liver transplant would affect his kidneys.

But at that time, she did not realize this meant she would become her husband’s care partner, helping administer his dialysis treatment at their home in rural Virginia. She had no prior medical training.

The couple said they settled on home dialysis after learning of the different in-center and home options through DaVita Kidney Care, which treats kidney patients around the country and participates in the Centers for Medicare & Medicaid Services (CMS) Innovation Center model (pilot program), the End-Stage Renal Disease Treatment Choices (ETC) Model. The CMS program encourages home dialysis and improving patients’ overall care and quality of life.

Jacqueline Samuel was supportive of home dialysis as it meant greater flexibility—it would be less disruptive to her husband’s life—and potentially lead to better health outcomes. However, it also meant she needed to take on additional responsibility, which came with some stress.

“I didn’t want to do anything wrong. I didn’t want to do anything to hurt him,” she said.

Very quickly, however, she said she gained confidence thanks to training she received and regular practice, and communication with her husband’s care team.

The length of training programs varies, but for most, it takes a couple of weeks, according to DaVita. The training for care partners includes learning how to insert needles and operate the dialysis machine. Many patients are unaware of the option or might be intimidated by taking on that care at home.

“A lot of patients don’t know what they don’t know. Once you provide that education, they realize that is something they can do in their home,” said Dr. Mihran Naljayan, Chief Medical Officer for Home Therapies and Pediatrics at DaVita. “It’s really about educating.”

At first, Jacqueline Samuel’s husband completed a few dialysis sessions in-center, but he said they left him weak, and he was concerned about a higher rate of infection going into a center with other dialysis patients.

“I have seen him go through that process in center and he didn’t do well with it, it wasn’t what he wanted to do,” she recalled. 
But now, because of Jaqueline Samuel’s support and training, her husband does dialysis from the comfort of their home. The process includes prepping all the equipment, and then inserting a needle into his arm, which allows her husband’s blood to circulate and filter through the machine (since his kidneys can no longer perform this function) before returning to his body.

Home dialysis has allowed Connor Samuel to continue working as a credit recovery teacher at Northumberland High school, where the couple first met as students and high school sweethearts, and where Jacqueline Samuel also worked as a counselor.

“He wanted to continue to work, so I had to be there to help him to continue to do that and I’m glad that we did,” his wife said. “I think we made the best decision.”