Pulmonary Mechanical Ventilation at Home: A Reasonable and Less Expensive Alternative

Abstract

The long-term care of ventilator-dependent patients often presents financial and moral burdens. During a 38-month period, January 1978 through February 1981, we provided home care for 10 ventilator-dependent patients, four of whom were com- pletely ventilator-dependent, 24 hours a day, at the time of their discharge from the hospital. Four patients had amyotrophic lateral sclerosis, three had restrictive chest wall disease, and three had miscellaneous disorders (chronic polyneuropathy, multi- ple sclerosis, and alveolar hypoventilation). The length of their home care during our observation period ranged from 2 to 38 months. As our home care program evolved, our conception of home care ventilation expanded from its being a necessity for getting certain patients discharged from institutional care to its being an alternative to institutional care or death. A team approach by physician, psychiatrist, nurse, respi- ratory therapist, physical therapist, occupational therapist, and social worker facili- tated home care. Home care proved to be less costly by far than institutional care; estimated savings during our observation period from the use of home care for these 10 patients was approximately $2.8 million. We learned that a long-term psychological evaluation process is vitally important to the success of a home care program. Further support for this type of health care by third-party payers and professional societies is necessary to establish criteria and standards for the provision of services and reim- bursement for them. (Sivak ED, Cordasco EM, Gipson WT. Pulmonary Mechanical Ventilation at Home: A Reasonable and Less Expensive Alternative. Respir Care 1983;28:42-49.