Psychosocial aspects of prolonged ventilator dependency.

Placement of the ventilator-dependent patient must take into consideration the psychosocial aspects of the situation. These include the patient's age, level of emotional and cognitive function, financial status, insurance benefits, cultural and personal-experience influences regarding life-threatening illness and institutionalization, and the availability of suitable caregivers. The hospital provides the greatest physical security but is expensive and allows minimal patient autonomy and family involvement. A nursing home is homier and less expensive, but it must have a staff well trained in the complex care of these patients and someone to oversee execution of the care plan, and its cost may not be adequately reimbursed by private insurance. Home care usually provides the best conditions for the patient, but it requires trained and available health professionals; a committed physician; education of the patient, family, and attendants; a suitable residence; a system for delivery and maintenance of supplies and equipment; and dependable financing; and it must allow the patient increased independence, socialization, and activities of daily living. Ventilator-dependent patients commonly experience fear, feelings of total dependency, and even degradation. Caregivers can relieve these feelings by reassuring the patient about safety measures, by keeping him informed about medical procedures, and by establishing communication.