Year: 2026
Type: article
Study design: Observational Study
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.
Author: Avi Kapoor
Language: English
Topic: Nursing care and research
Subfield: Research and Theory
Field: Nursing
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W7223883999