There are currently over 350,000 patients in the United States on dialysis, with more than 90% receiving conventional in-center thrice-weekly hemodialysis (HD). Less than 1% of patients receiving HD are at home, and of these approximately 1500 patients receive more frequent and usually longer dialysis sessions. This article provides a historical perspective of HD at home, followed by practical considerations for short daily HD (SDHD) and long nocturnal HD, contrasting the strengths and limitations of these modalities. Finally, frequent and longer dialysis therapy is put forth as the best way to improve patient outcomes. It suggested that the optimal location in the present dialysis delivery system for more frequent and longer dialysis is in the home.