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Choosing A Ventilator Care Program With advanced medical technology and clinical expertise people are surviving catastrophic illness more often. For patients and their families this often embarks them on a journey through a medical system that can be difficult to navigate. It is common for families to be told while in the hospital that their loved-one no longer qualifies for an acute level of care. This can be a very confusing statement when the patient is hooked to a life support system and may have intravenous and feedings through other multiple tubes. Why Doesn't My Loved-One Qualify to Stay in the Hospital? Hospitals for the most part have become centers to care for people during the acute phase of their illness. No longer do you go to a hospital and stay until your recovery is completed. Once the acute phase of the illness is over and you are considered “stable” the hospital will refer you to a long-term ventilator care program. Stability when referring to the ventilator dependent patients can mean multiple things. It may mean the patient no longer requires cardiac monitoring, medications given intravenously to maintain blood pressure, the source of the original illness has been identified and is resolving, laboratory values have returned to normal limits or the attempts at weaning from the ventilator have failed to succeed. What is a Long-Term Ventilator Care Program? A long-term ventilator care program is usually a part of a skilled nursing facility. It has special requirements for staffing and care. It has doctors, nurses, respiratory therapists, and the other specialties needed to provide for your care. Each facility is individual in its programming, weaning and rehabilitation. Some facilities admit very complex patients while others focus on the more chronic. How Do I Choose a Ventilator Program? When choosing a program for a loved one's recovery you will have to do some research, ask questions of the programs staff, ask for statistics and make sure you visit the program. Below is a list of questions and criteria you can use to measure a ventilator care program: Research :: What programs are available in your area :: What services do they provide Questions :: Do board certified pulmonologists see the patients? :: What is the staffing ratio of professional staff to patient? :: What are the protocols for ventilator weaning? :: What services are available to the patient? :: How often does the attending physician see the patient? :: What kind of monitoring do the patients receive? :: Will rehabilitation be provided by physical, occupational and speech therapy? If so what is the criteria for initiating and termination of therapy? :: How often do the patients get out of bed? :: Does the program have portable ventilators allowing my loved-one more mobility? :: How does the program discharge or transfer patients? :: How did the program rate on state survey? :: How often is the family formally updated through care conference or team meetings? :: Can you speak with other families or patients in the facility? :: Can you participate in direct care training if you desire? :: What type of recreation, activity and support programs are provided? :: Does the program have pet therapy or pet visits? :: Are there religious services provided? If so is my loved-ones denomination represented and if so how often are services and visits provided? :: Can you schedule a tour even during non-traditional business hours? :: Who are the go-to people should I have any questions once my loved-one is at the program and when are they accessible? Statistics :: What percentage of the program's patients wean from the ventilator? :: How long on average does it take the program to wean a patient? :: How long on average does it take the program to be able to remove the tracheostomy tube from the patient? :: What patients are included in the statistics? :: How many patients speak using valves or other devices? :: How many patients progress to oral feeding? :: How many patients obtain their previous level of function? Program Visit :: Are the outside grounds and parking clean, well lighted and provide easy access? :: What level of security is provided? :: Is he program staff pleasant. Do they smile and interact with patients and with fellow staff :: Does the staff appear to be attentive to patients needs? :: Do the patients you see appear well cared for? :: Are the rooms spacious, bright, clean and free from odors? :: Are you able to speak with direct care staff on the unit? :: Are you able to speak with other patients? Once I Have Chosen a Ventilator Care Program How is the Patient Transported There? Once a facility has accepted the patient the social worker or discharge planner at the hospital will arrange for transportation. Normally the patient is transferred via ambulance with paramedic and sometimes a respiratory therapist to ensure a smooth transition. A portable ventilator or manual ambu-bag will be utilized to support the patients breathing during transport. The ambulance is equipped with the oxygen and suction equipment that may also be necessary. Once At The Program What Will My Loved-One Need? Now that the rehabilitation phase of your loved-one's care has begun you will need the daily items they would use at home with a few modifications. You will need to bring regular clothing but since there is a tracheostomy tube and perhaps a feeding tube a few helpful tips are shirts or blouses that button or zip allow for the extra room needed at the neck. Pants such as sweats are usually found most comfortable. They allow for easy mobility and that is important during exercise. Shoes or sneakers with a non-skid sole that are well fitting will be the best for walking and exercising. Slippers should also have a non-skid sole. Socks should be soft with elastic top that is not binding. Women may want their make-up case and men their personal shaver. Glasses and hearing aides are essential and should be brought with the patient. It is important that whatever clothing items are brought the facility will need to label them with the patient’s name. Check with the program as to what there requirement is. Another hint that will help prevent frustration and disappointment is to remember that clothing will be laundered in a commercial manner. High heat water temperatures or strong detergents and disinfectants may be used for bacterial control so delicate fabrics and those that shrink should be avoided. Non-essential jewelry should be left at home. It is probably wise to have at least a seven-day supply of all clothing items. This allows for changing of clothing items that become soiled and the lag time for laundry return. Individual programs can tell you what they recommend. Personal items that bring comfort such as pictures, favorite blanket, music or books are encouraged. Who Do I Contact if I Have Questions? The admission department will be able to direct your questions to the right individuals. Once the patient has been admitted the social worker will be able to direct you to the correct individuals. Ask for a listing of phone numbers for those directing your loved ones care this will help alleviate being shuffled from one extension to another. What Does the Program Need From Me on the Day of Admission? They will need the name address and phone number(s) of an emergency and primary contact person. At this time the patient (if able) will be asked who is allowed information about them. Only those specifically named by the patient will receive information all other family and friends must get patient updates from those designated. Copies with the appropriate seals and signatures of any legal documents directing your care such as a living will, healthcare proxy, power of attorney or guardianship and do not resuscitate (DNR) paperwork. Copies of insurance information should be provided if applicable. The staff should be informed of personal preferences such how your loved-one wishes to be referred to by name, TV programming, music choices, normal awake and asleep times to help provide the most comfortable setting possible. You will be asked to sign admission agreements and other necessary paperwork. It is usually best to get the admission paperwork accomplished while the floor staff are assessing and making the patient comfortable and familiar with their new surroundings. What Is The One Thing I Need to Remember? When in doubt - always ask questions. 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