Home care for children dependent on ventilators or other equipment is increasingly common. Until recently, such children remained in acute-care hospitals, using vast amounts of resources, even when they required less-than-acute care. Less than a decade ago, only a few demonstration projects in this country routinely attempted to return ventilator-dependent children to their homes and back into the community.1 Today, an expanding home-care industry assists many established centers, pediatricians, and specialists in this transfer. The trend toward home care has been stimulated by rising societal expectations, awareness of the needs of the disabled, the increasing number of children rescued from formerly lethal conditions but sustaining disability in the process, and the high cost of inpatient care in acute-care facilities.
Clearly, the foremost pressure is financial. Third-party payers, both public and private, do not believe they can sustain the high costs of maintaining such children in