It’s the Summer Travel Season: Tips for Your Home Dialysis Patients
It’s blazing hot in many places. If your patients are like me, this may make them dream of going to a cooler climate or to a beach or another fun tourist spot. There are ways to help patients live their best lives, including traveling.
Planning the Getaway
It’s important to let your patients know that travel is possible by land, air, and sea. PD patients who use a cycler or home HD patients who use NxStage can take their machines with them and bring the supplies they’ll need or have them shipped to their destinations. Let them know how far in advance they need to notify you if they want supplies shipped, and whether shipping will be free or have a cost. Within the continental U.S.—with enough notice—supply shipping is typically free. Well-traveled patients share tips for traveling in their KidneyViews blog posts on Home Dialysis Central. You can share this link with your patients.
Home HD patients who use large HD machines need to dialyze at a clinic at their destination. They need to know how vital it is to plan ahead. Some clinics in tourist locations can be remarkably busy, and distance to the closest clinic and scheduling dialysis can be a challenge. Unless travel is required for a death or other emergency, in most cases patients need to alert you at least 30 days before they want to travel, and longer is better.
You may need to explain to home HD patients that they will need to limit their diet and fluid intake more with in-center dialysis than they normally would if they do dialysis at home longer than 3-4 hours or more than 3 days a week. Ask the dietitian to help them plan ahead for how to stay healthy while enjoying their trip.
Paying for Dialysis While Traveling
The social worker and/or financial counselor (some dialysis corporations have one) can help patients understand payment for dialysis when traveling. When patients do PD or home HD outside their state or the U.S. with supplies and equipment a clinic provides, this is typically billed to Medicare, Medicaid, and commercial insurance as if the patient is at home. A patient who chooses to do in-center HD overseas needs to ask what the cost will be. Here are the basics:
Traditional Medicare pays for dialysis in the U.S. and U.S. territories, including American Samoa, Guam, Northern Mariana Islands, and other Pacific Islands, Puerto Rico, and the U.S. Virgin Islands.
Even Medicare Advantage plans that only cover services at network providers in a certain area must cover dialysis at 80% just like Traditional Medicare when a patient is traveling.
Patients with commercial insurance need to check their plan coverage for dialysis. These plans may cover in-center dialysis outside the U.S. better than Medicare does.
Medicaid covers dialysis in the state a patient lives in and may pay for in-center dialysis in border states. If a patient with Medicaid wants or needs to travel outside that area for in-center dialysis, the cost can be challenging.
Resources for Traveling Dialysis Patients
Consider making a list of resources to share with patients to help them travel. Some large dialysis organizations can help with travel for in-center dialysis or backup clinics for home dialysis support. These include:
The U.S. 9/11 attacks led to passage of the Aviation and Transportation Security Act that set up the Transportation Security Administration (TSA). The TSA website has a wealth of helpful information for those who plan to travel by air. Among those helpful resources are:
A downloadable PDF checklist to help travelers know how to pack to follow TSA’s rules
Information on screening, including an infographic comparing screening for standard passengers and those with TSA PreCheck. New TSA rules do not require taking shoes off.
TSA Cares can help all kinds of people, including those with disabilities and health conditions.
How TSA Cares can Help
TSA Cares can provide information and guidance for people with disabilities with the screening process:
Patients who plan to travel with a dialysis machine, supplies, and/or certain medications should contact TSA Cares at (855) 787-2227 from 8 a.m. to 11 p.m. Eastern time weekdays or 9 a.m. to 8 p.m. Eastern time weekends and holidays to ask for what they need at least 72 hours before their flight.
Another option is to fill out a form to ask for help.
A Passenger Support Specialist (PSS) can assist with screening, and this 3-minute video shows how. Patients who cannot walk through a screening device should tell the TSA PSS, so they can have a pat down by a same-sex TSA agent.
The TSA Cares website has a TSA Notification Card: Individuals with Disabilities and Medical Conditions (fillable PDF) patients may want to complete, print, and bring along on their trip with their other paperwork.
Airline Assistance
With advance notice, airlines can arrange for a wheelchair to help a patient get to the gate and on the plane. Airlines must allow patients to travel with dialysis equipment and supplies under the Department of Transportation’s (DOT) Guidance on the Transport of Portable Dialysis Machines By Travelers with Disabilities. Written in a question/answer format, it states:
Those on dialysis can fly with a dialysis machine and cannot be charged extra for it. Patients should check with the airline to find out if their PD machine is small enough to fit in the overhead bin. Current HD machines with a case weigh 100 pounds or a little more. The Guidance says they can go in the baggage compartment in most commercial airlines and are given priority over other luggage. Popping an Apple Airtag in the case can be a good way to track a misplaced machine.
Airlines must allow passengers to travel with medical supplies, medications, syringes and dialysis fluids at no extra charge. Patients should declare these to TSA and they are subject to inspection. Patients should plan to take medications in a carryon bag, not in checked luggage, which could go astray. Dialysis fluids and other supplies can be checked with baggage, marked as medical supplies (no personal effects can go in a medical supply box). The DOT can’t require an airline to allow a passenger to take more than 1 to 2 days’ worth of dialysate. Ask the PSS about this; many patients have traveled with more.
Patients can contact the complaint resolution official (CRO) at 1-800-778-4838 (voice) or 1-800-455-9880 (TTY) from 9 a.m. to 5 p.m. ET Monday through Friday except federal holidays, if an airline refuses to take their machine, medications or supplies.
Unforeseen things may happen when traveling. If an item—including a dialysis machine—is lost or damaged on a flight in the U.S., U.S. airlines must base what they pay for loss or damage on the original purchase price. Since few U.S. patients own their machines, payment should go to whoever does—the clinic or device company that rents it to the clinic. Clinics should know this. NOTE: The Montreal Convention applies to lost or damaged items on international flights.
Final Thoughts
For many, travel is one of the joys of life and may be a reason why patients choose home dialysis. Traveling on dialysis does require extra planning. Encourage patients to ease into travel by taking a short overnight trip or two before taking an extended vacation. These trial runs can give them confidence that they know what to bring and how much they’ll need each day.
Patients who have traveled extensively advise creating a checklist for medical supplies. They need to be prepared as much as possible for unexpected things, like lost or damaged supplies, malfunctioning machine, illness, etc. They need to know who to contact and/or where to go if they have a problem while traveling.
Encourage your patients to join the closed (member’s only) Home Dialysis Central Facebook group. After responding to a few questions to be admitted, they can ask the group about travel and learn from expert patients. In the group Files, there are checklists, medical supply labels, and much more. Helping your home dialysis patients travel will be as rewarding for you as it is for your patients, as you give them opportunities to see and do new things.
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