Asunto(s)
Servicios de Atención de Salud a Domicilio/normas , Respiración Artificial/normas , Adulto , Apnea/terapia , Niño , Enfermedad Crónica/terapia , Costos y Análisis de Costo , Humanos , Humedad , Inhalación , Respiración con Presión Positiva Intermitente , Enfermedades Pulmonares Obstructivas/terapia , Monitoreo Fisiológico , Enfermedades Musculares/terapia , Fenómenos Fisiológicos de la Nutrición , Oxígeno/administración & dosificación , Grupo de Atención al Paciente , Cooperación del Paciente , Respiración Artificial/economía , Respiración Artificial/psicología , Insuficiencia Respiratoria/terapia , Factores de Tiempo , TraqueotomíaRESUMEN
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.
Asunto(s)
Cuidados a Largo Plazo , Alta del Paciente , Respiración Artificial/normas , Servicios de Atención de Salud a Domicilio , Hospitalización , Humanos , Instituciones Residenciales , Instituciones de Cuidados Especializados de Enfermería , Estados UnidosRESUMEN
Some patients requiring long-term intermittent or continuous mechanical ventilation can be safely treated at home with less cost and greater patient and family satisfaction. This is supported by experience with restrictive or obstructive respiratiroy disease patients in a respirator home care program from 1973 through 1979; some were followed for over four years. Moreover, risk is low as judged by few medical complications and no deaths attributed to home care. When compared with their need for hospitalization in the preceding 12 months, patients in the home care program required fewer days in the hospital (restrictive, 88 percent; obstructive, 37 percent). Given proper organization and resources, home care can be a useful alternative to continued hospitalization for certain respirator-dependent patients.