The Advancing American Kidney Health Initiative heralded a new era in American kidney care. As home dialysis doctors, we were excited about the emphasis on home dialysis. In practical terms, however, nothing has changed for patients themselves. Our patients and their care partners continue to perform medical procedures that are usually the province of professionals, incur unexpected expenses, and manage complicated logistics, the day-to-day details of which are often underestimated and overlooked by policymakers.