Prolonged Mechanical Ventilation: A Comparison of Patients Treated at Home Compared With Hospital Long-Term Care

2020 ◽  
Author(s):  
Jeremy M. Jacobs ◽  
Esther-Lee Marcus ◽  
Jochanan Stessman
Keyword(s):  
Mechanical Ventilation ◽  
Long Term Care ◽  
Prolonged Mechanical Ventilation ◽  
Term Care ◽  
At Home

scholarly journals PROLONGED MECHANICAL VENTILATION: CHARACTERISTICS OF PATIENTS TREATED AT HOME COMPARED TO HOSPITAL LONG-TERM CARE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S447-S447
Author(s):  
Jeremy M Jacobs ◽  
Esther-Lee Marcus ◽  
Jochanan Stessman
Keyword(s):  
Mechanical Ventilation ◽  
Long Term Care ◽  
Prolonged Mechanical Ventilation ◽  
Functional Decline ◽  
Healthcare Providers ◽  
Term Care ◽  
Advanced Directives ◽  
Clalit Health Service ◽  
At Home

Abstract Rising numbers of patients receiving Prolonged Mechanical Ventilation (PMV) pose a challenge, and advancing technology supports ventilators appropriate for either Home or Hospital Long Term Care (HLTC).Data guiding decisions concerning place of care are lacking. This study describes the characteristics of the majority (120/123) of all PMV patients aged ≥18 (and their caregivers) in Jerusalem, covered by the Clalit Health Service, treated either with Home Hospital or HLTC. Patients were more alert and communicative at Home vs. HLTC (40/46 vs. 22/74), younger (54 vs.73 years, p12 years (36% vs.21%, p=0.1), and without legal guardian (59% vs. 12%, p<0.01). Primary reason for PMV at home was degenerative neuromuscular disease (59% vs. 28%), compared to post resuscitation/sepsis/CVA in HLTC patients (17% vs. 62%), who suffered more comorbidity, functional decline post-PMV, and pressure sores (0% vs. 42%). Ventilation was more likely to be planned at home vs HLTC (33% vs. 8%), and yet 119/120 were without Advanced Directives prior to PMV. Caregivers at home tended to be spouses (48% vs. 31%) and offspring at HLTC (17% vs. 47%), with reduced Modified Caregiver Strain Index at home (10.5 vs. 12.9, p=0.12). Mortality during follow-up was lower at home (15.2% vs. 27%). Costs to the health fund for home versus HLTC were approximately 1:3. Our findings suggest that with appropriate targeting of eligible PMV patients, Home Hospital may be the preferred model of care for patients, caregivers and healthcare providers.

scholarly journals Prolonged Mechanical Ventilation At Home Versus Long Term Care: Caregiver Characteristics And Strain

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 803-804
Author(s):  
Esther-Lee Marcus ◽  
Jeremy Jacobs ◽  
Jochanan Stessman
Keyword(s):  
Mechanical Ventilation ◽  
Emotional Disturbance ◽  
Long Term Care ◽  
Prolonged Mechanical Ventilation ◽  
Financial Burden ◽  
Term Care ◽  
Emotional Strain ◽  
Feeling Overwhelmed ◽  
At Home

Abstract Although the number of Prolonged Mechanical Ventilation (PMV) patients and their informal caregivers (CGs) is rising both at Home or Long Term Care (LTC), little is known concerning CG characteristics or strain. We enrolled 120 patients and 106 informal CGs: 34/46 and 72CGs/74 PMV patients from Home Hospital and LTC respectively. CGs were married (82%), female (60.4%), mean age 59 ±14 years; spouses (29%) or children (40%) of the PMV patient. The 13-item Modified Caregiver Strain Index (MCSI) (Maximum severity=26) was 13.6± 6.5, similar at Home vs. LTC (14.3±7.5 vs. 13.3±6.0, p=0.9). Most frequent complaints were distress concerning patient’s changes (93%) or upsetting behaviours (82%), feeling overwhelmed (82%), sleep disturbance (69%) and emotional adjustments (67%). Home CGs reported significantly more physical and financial burden, confinement, and need for work adjustment, while LTC CGs reported greater emotional disturbance and upsetting patient behaviours. Hierarchical clustering identified three clusters of CG strain: burden (physical/time/financial), emotional (upsetting adjustment/ behaviours/overwhelmed) and disturbance (work/plans/confinement). Emotional strain was most frequent, irrespective of site of care; however CGs at Home vs. LTC experienced significantly higher burden and disturbance vs. higher emotional strain respectively. In multivariate models, after adjusting for numerous patient and CG variables, increasing CG strain was consistently associated with rising patient symptomatology. This relationship was pronounced among CGs of Home PMV patients, with a significant interaction variable of Home*Patient symptomatology. Our findings identify specific patterns of strain among caregivers of PMV patients whether at home or LTC, and highlight the importance of addressing their unique needs.

Ventilator-Dependent Survivors of Catastrophic Illness Transferred to 23 Long-term Care Hospitals for Weaning From Prolonged Mechanical Ventilation

CHEST Journal ◽  
2007 ◽  
Vol 131 (1) ◽  
pp. 76-84 ◽  
Author(s):  
David J. Scheinhorn ◽  
Meg Stearn Hassenpflug ◽  
John J. Votto ◽  
David C. Chao ◽  
Scott K. Epstein ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Long Term Care ◽  
Prolonged Mechanical Ventilation ◽  
Term Care ◽  
Catastrophic Illness

Post-ICU Mechanical Ventilation at 23 Long-term Care Hospitals

CHEST Journal ◽  
2007 ◽  
Vol 131 (1) ◽  
pp. 85-93 ◽  
Author(s):  
David J. Scheinhorn ◽  
Meg Stearn Hassenpflug ◽  
John J. Votto ◽  
David C. Chao ◽  
Scott K. Epstein ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Long Term Care ◽  
Term Care

Informal caregiving for frail older people at home and in long-term care institutions: who are the key supporters?

1999 ◽  
Vol 7 (6) ◽  
pp. 434-444 ◽  
Author(s):  
◽  
John Bond ◽  
Graham Farrow ◽  
Barbara A. Gregson ◽  
Claire Bamford ◽  
...  
Keyword(s):  
Older People ◽  
Long Term Care ◽  
Informal Caregiving ◽  
Frail Older People ◽  
Term Care ◽  
At Home

Long-Term Care at Home

2014 ◽  
Author(s):  
Doron D. Goldman ◽  
Regina Khurin ◽  
Debora W. Tingley ◽  
Darlene Yee-Melichar
Keyword(s):  
Long Term Care ◽  
Term Care ◽  
Care At Home ◽  
At Home
Sign in / Sign up

Export Citation Format

Share Document