Marianne W. was diagnosed with kidney failure two years ago. Because of multiple comorbid medical problems, she is not a transplant candidate. Marianne’s nephrologist has discussed dialysis with her, but she reacts very negatively, having watched her father endure multiple complications while on dialysis: “That wasn’t living!” Marianne lives alone, in unstable and unsafe subsidized housing, with her two adult children living nearby. However, Marianne shares, “They each have their own families and responsibilities,” so she cannot count on them for regular support. Marianne has missed her last three nephrology appointments and is now admitted for the second time in two months with decompensated chronic kidney disease. Her medical team believes that without dialysis, she will keep requiring hospitalization, but when seen by the nephrology consultant, she shuts down and refuses to talk.