Pulmonary mechanical ventilation at home: a reasonable and less expensive alternative.

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 completely 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, multiple 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, respiratory therapist, physical therapist, occupational therapist, and social worker facilitated 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 reimbursement for them.