Technology-dependent children in New York State.

A survey in New York State revealed 210 medically stable technology-dependent children retained inappropriately in acute-care hospitals. They remained in hospitals primarily because of a shortage of skilled home nursing services in the communities where they lived, family problems that prevented their care at home, and a shortage of beds in appropriate skilled nursing facilities. Most of the children were younger than one year of age, most had disorders of the central nervous system or respiratory system, and most needed respiratory support. The average child needed more than 13 hours of skilled nursing care per day. With adequate nursing services, many of these children could be cared for in their homes. For some, family care was not feasible because of social, psychological, and economic problems. To make it possible to care for medically stable technology-dependent children most effectively, we must develop additional community-based resources. Home nursing services of the highly skilled kind needed to care for them are in short supply today in New York State. There is a shortage of beds in extended care nursing facilities capable of caring for them, especially for infants and very young children. There is a shortage of the other supportive social services needed by families who attempt to care for them at home. Until we address these needs and develop these services, technology-dependent children medically appropriate for care outside acute-care hospitals will be forced to remain hospitalized, to the detriment of the children and their families.