Protecting the most vulnerable: home mechanical ventilation as a case study in disability and medical care: report from an NIH conference.

Patients requiring chronic mechanical ventilation represent a particularly vulnerable segment of the expanding population of individuals with chronic disabilities. Many of these individuals can live successfully at home, but face significant obstacles. Current policies in health care coverage, durable medical equipment coverage, eligibility for assisted living, and licensing of caregivers all restrict the abilities of these individuals to live in the community. Prolonged home mechanical ventilation was pioneered in France, where a current international "best practice" provides a model for developing comprehensive, cost-effective care for these individuals.