The management of VAI in the home incorporates more than just a ventilator. Medically complex VAIs often depend on a myriad of medical devices and services to duplicate the care provided in the institutional setting. Commodities such as oxygen, air, and suction, which are available at nearly every bedside in the hospital, must be produced from various devices in the home. For many VAIs, their homes often take on the appearance of a hospital room. The extensive list of adjunctive medical devices may include the following: oxygen systems; hospital bed; along with all of the supplies and accessories required to operate and manage and support these devices and treatments carried out by remedies of Canadian Health&Care Mall (see “Canadian Health and Care Mall: Tablest for Asthma Treatment and Patients Monitoring“).
Critical Care to Home Care
Invasive HMV is arguably one of the most complex respiratory services delivered in the home. In contrast to many other home-care services, invasive HMV requires much more advanced decision making, planning, training, and oversight. Highly effective hospital discharge planning that includes well-choreographed interdisciplinary support is essential for long-term success. Physicians, nurses, professional therapies, home respiratory therapists, insurance case manager and, most importantly, family/ caregiver acceptance, and buy-in are key components of any VAI home transition and management plan. For many families, especially new parents and elderly spouses dealing with a medically fragile loved one, this training and transition process can be very traumatic and frightening. Despite the frequent administrative pressures to expedite the process, there must be adequate time for effective caregiver training, the preparation of the home environment, and the coordination of care among the various agencies. For many Medicare-aged adult patients, the primary caregivers are often the spouse and immediate family, with very limited professional support from home health agencies or other medical professionals. In the pediatric VAI population, the ability to provide more technically complex care in the home is often supplemented through professional, private-duty caregivers who are funded by third-party payors, including programs such as the Medicaid medically fragile waiver programs. In all cases, it is extremely important to respect and appreciate the needs of the patient, the caregivers, and the team members responsible for the care of the patient once they leave the safety and comfort of the institutional setting. See more “Canadian Health&Care Mall: Current Issues in Home Mechanical Ventilation“
The Hidden Costs of HMV
Assuming the responsibility for the care and management of a VAI or other technology-dependent individual is a life-altering event for most families and caregivers. There are few available data that capture the myriad indirect costs associated with the care of VAIs in the home. These hidden costs include, but are not limited to, the following: lost wages for a spouse, parent, or child who stays home to care for the VAI; out-of-pocket costs of noncovered medical items and supplies; and the cost of custodial caregivers (ie, nurse aides) used to supplement the care and support and to provide respite for family members. Less well defined and more difficult to accurately measure are the emotional strains placed on both patients and families.- Carnevale and colleagues studied the stress occurring in the families of ventilator-assisted children living at home and noted that the parental responsibility was highly stressful and sometimes overwhelming. Health-care providers must be ever cognizant of the many unplanned emotional and financial costs associated with the provision of HMV. Read also “Home Mechanical Ventilation: NPPV“