The Household as Dialysis Infrastructure : Family Caregiving, Poverty, and In-Center Hemodialysis in Delaware.
- 1Student Intern, MayaMD.
Abstract
Objectives
To examine how maintenance in-center hemodialysis redistributes unpaid labor, financial strain, and emotional responsibility within low-income Delaware households.Methods
After background review and survey development from October 2025 through April 2026, a cross-sectional mixed-methods survey was administered during July-August 2026 in greater Wilmington, Delaware. Participants were 48 adult unpaid family caregivers of adults receiving maintenance in-center hemodialysis from low-income households. Recruitment used remote and community-based kidney-care channels, including MayaMD, a virtual nephrology care company, Wilmington-area community health organizations, and clinical social-worker flyers. Quantitative items assessed caregiving time, household effects, resource insecurity, and perceived burden; open-ended responses were analyzed thematically.Results
Caregivers reported a mean of 28.7 hours of kidney-related care weekly. Transportation and waiting accounted for the largest share of time. Sixty-nine percent missed work or school, 63% changed household food purchases, 50% delayed their own health care, 46% reported food insecurity, 27% lacked reliable private transportation, 65% reported moderate or high financial strain, and 58% reported moderate or high emotional strain. Open-ended responses showed that caregivers experienced dialysis not only as a treatment schedule but as a household system of work, obligation, rationing, and role negotiation.Conclusions
Dialysis treatment in low-income households depends on unpaid family infrastructure that is clinically necessary but insufficiently measured. Low-income caregivers did not merely assist care; they absorbed transportation, food, employment, and emotional costs that shaped treatment continuity.Policy implications
Delaware dialysis and public health systems should treat caregivers as part of chronic-disease infrastructure by screening for strain and coordinating transportation, nutrition, social-work, employment, and respite supports.
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BibTeX
@article{kapoor2026household,
title = {{The Household as Dialysis Infrastructure : Family Caregiving, Poverty, and In-Center Hemodialysis in Delaware.}},
author = {Avi Kapoor},
journal = {Delaware journal of public health},
year = {2026},
month = oct,
doi = {10.32481/djph.2026.10.13},
url = {https://europepmc.org/article/MED/42948830},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - The Household as Dialysis Infrastructure : Family Caregiving, Poverty, and In-Center Hemodialysis in Delaware.
AU - Avi Kapoor
PY - 2026
DA - 2026/10/26
JO - Delaware journal of public health
DO - 10.32481/djph.2026.10.13
UR - https://europepmc.org/article/MED/42948830
AB - Objectives To examine how maintenance in-center hemodialysis redistributes unpaid labor, financial strain, and emotional responsibility within low-income Delaware households.Methods After background review and survey development from October 2025 through April 2026, a cross-sectional mixed-methods survey was administered during July-August 2026 in greater Wilmington, Delaware. Participants were 48 adult unpaid family caregivers of adults receiving maintenance in-center hemodialysis from low-income households. Recruitment used remote and community-based kidney-care channels, including MayaMD, a virtual nephrology care company, Wilmington-area community health organizations, and clinical social-worker flyers. Quantitative items assessed caregiving time, household effects, resource insecurity, and perceived burden; open-ended responses were analyzed thematically.Results Caregivers reported a mean of 28.7 hours of kidney-related care weekly. Transportation and waiting accounted for the largest share of time. Sixty-nine percent missed work or school, 63% changed household food purchases, 50% delayed their own health care, 46% reported food insecurity, 27% lacked reliable private transportation, 65% reported moderate or high financial strain, and 58% reported moderate or high emotional strain. Open-ended responses showed that caregivers experienced dialysis not only as a treatment schedule but as a household system of work, obligation, rationing, and role negotiation.Conclusions Dialysis treatment in low-income households depends on unpaid family infrastructure that is clinically necessary but insufficiently measured. Low-income caregivers did not merely assist care; they absorbed transportation, food, employment, and emotional costs that shaped treatment continuity.Policy implications Delaware dialysis and public health systems should treat caregivers as part of chronic-disease infrastructure by screening for strain and coordinating transportation, nutrition, social-work, employment, and respite supports.
SN - 2639-6378
ER -