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Placement alternatives for long-term ventilator care.

Management of the patient receiving long-term ventilator care is facing many changes, among them new alternatives in placement outside hospitals. These include the home and two new options--the skilled nursing facility and the residential care facility. Government and insurance carriers are now more willing to pay for these alternatives to hospitalization. Home has been the traditional placement of choice for ventilator-dependent patients; this placement requires extensive training of the patient and careproviders to ensure safety. The skilled nursing facility (SNF) has been in the past an unsafe alternative placement; however, some SNFs are developing special units for ventilator-dependent patients that will make a placement to these facilities safe and practical. Residential care facilities, developed as a model program in California, can care for small numbers of ventilator-dependent persons in a homelike setting. These new placement alternatives will make it possible for virtually all medically stable, ventilator-dependent patients to live away from the hospital.