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home careThere exist rising concerns about the feasibility for safe and cost-effective home care programs for ventilator-dependent patients. Currently, such individuals reside for years in acute intensive care facilities at enormous costs in human and economic terms. Until recently, there were few viable institutional-based or community-oriented options. Home care demonstrations are now evolving into definite programs.

There are many pressures to develop the home care option. Home ventilator care is a proved, cost-beneficial concept which can help to counteract the rising costs of institutionalization for such persons. At the same time, home care brings enormous human benefits to the lives of patients and their families. Reimbursement agencies are now considering changes in policies, and government authorities are making changes in legislation, most significantly at the state level. An exploding home health care industry is ready and waiting to serve.

We are witnessing a transformation in health care delivery in America. Important experiences with home care and other suitable alternatives already exist which can serve as models for new evolving concepts. We can look back in history to evaluate the past experience with poliomyelitis in order to incorporate successful components of that experience that are appropriate to the current realities. In addition, we can look to Europe for existing programs that have had years of expanding experiences meeting the needs of ventilator- and oxygen-dependent persons.

Three important programs exist today that are worthy of study:

1. The Responaut Program is a hospital-based, operational program which provides needed services for ventilator-dependent persons in England who. are either at home with family members or living in the community because of the development of other suitable alternatives. This program began in 1965 and has served 411 patients; as of 6/15/83, it benefits 223 people with a highly personal home maintenance service as well as the hospital base-unit. (Phipps Respiratory Unit—St. Thomas’ Hospital, London).

2. The ADEP Program is a community-based, operational program which as of May 31, 1983 serves 672 ventilator- and oxygen-dependent persons in the Greater Paris Metropolitan Area. Services are provided according to a contractual arrangement with reimbursement authorities. ADEP provides equipment maintenance, quality assurance, case-monitoring, and coordination of available institutional resources. Costs vary from $3.50 to $13.35/day, depending on the clinical needs. The ADEP program includes home maintenance services, independent living centers for ventilator-dependent persons, and a documentation center providing information required by disabled people to live in the community.

3. The ALLP programi is a hospital-based (Croix-Rousse) regional program which serves 445 ventilator-and oxygen-dependent persons in the Lyon region of France. This program offers a computer-based coordination of hospital and home care services. The progran also includes an independent living center and an essential transitional care concept (Bellecombe— Hauteville).

These experiences serve to illustrate the important components of success in regional programs that implement the concept of home ventilator care. It is essential to study the clinical and organization success of these approaches to learn what is applicable to our evolving home health care needs.