Ventilator and Tracheostomy Care at Home

Care by condition

Living at home on a ventilator is possible in Ontario, and a good number of people do it. It needs a level of staffing that most agencies cannot honestly provide, which is why the answer to “can you actually cover the shifts?” matters more here than on any other page of this site.

We will tell you plainly whether we can staff your schedule in your community before you commit to anything.

What actually changes at home

• This is coverage, not visits. The unit of care is a shift, and the schedule has to close completely — there is no version of it where a gap is merely inconvenient.
• A missed shift is a safety event, not a service complaint. That is the whole reason to ask hard questions about staffing depth before you sign anything.
• Secretions run the day. Suctioning frequency, humidification and cough assist shape everything else, including sleep.
• Communication changes. A tracheostomy alters or removes the voice, and the household has to build a way of being understood that does not depend on it.
• Equipment failure needs a plan that is written down and known by everyone in the house, not held in one person’s head.
• The family becomes expert and exhausted at the same time, often having been the primary carer through a hospital stay first.

Equipment and funding in Ontario

The equipment side is better organized in Ontario than most people expect, and it is worth knowing about before you start paying for anything privately.

• The Ventilator Equipment Pool is a provincial service run by Kingston Health Sciences Centre and funded by the Ministry of Health. It has been running since 1994.
• It supplies mechanical ventilators, BiPAP units with a backup rate, cough assist devices, mechanical insufflator-exsufflators, and oxygen saturation monitors for people under 19.
• It is provided at no cost to people who live at home, need the equipment to survive, and have been approved under the Ministry of Health’s Assistive Devices Program.
• It also provides round-the-clock telephone technical support, repair, in-home or virtual training, and remote ventilator monitoring by respiratory therapists.
• Ontario Health atHome arranges publicly funded nursing for people who qualify, and for long-term ventilation the publicly funded hours are usually the foundation that private hours are built on top of — not the other way round.

Equipment eligibility is decided by the Assistive Devices Program and the Ventilator Equipment Pool, and nursing hours by Ontario Health atHome. Ask both before assuming you have to fund it yourself.

How we help

• RN and RPN shifts, including nights, at the length your schedule actually needs
• Tracheostomy care and suctioning, and monitoring of secretions and skin around the stoma
• Ventilator circuit checks, alarm response and escalation against a written plan
• Cough assist and chest physiotherapy support where it has been prescribed
• Enteral feeding and medication where that is part of the plan
• Structured handovers between shifts, written down, so nothing depends on memory
• Teaching and backup for family carers who want to do some of the care themselves
• Respite, so a parent or spouse is not the permanent night nurse

Who provides the care

This is nursing care. Tracheostomy suctioning and ventilator management are controlled acts in Ontario and a personal support worker may not perform them — so these shifts are staffed by RNs and RPNs, with the mix depending on stability and on what the care plan requires. A PSW can support the rest of the household routine alongside the nurse, which is often the affordable way to build a week.

Common questions

Can you actually cover 24 hours a day?

In some communities yes, in others not reliably, and we would rather tell you which before you depend on us. Ring us with your postcode and your schedule and you will get a straight answer about staffing depth rather than a yes that falls apart in week three.

Who supplies the ventilator?

In Ontario, usually the Ventilator Equipment Pool, a provincial service run by Kingston Health Sciences Centre and funded by the Ministry of Health. It supplies ventilators, BiPAP with a backup rate, cough assist and insufflator-exsufflators at no cost to people approved under the Assistive Devices Program who live at home, and it runs 24-hour technical support.

Can a PSW do the suctioning?

No. Tracheostomy suctioning and ventilator management are controlled acts and require an RN or RPN. Any agency that tells you otherwise is one to walk away from.

What happens if a nurse cannot attend a shift?

You get told immediately, and we work the replacement rather than leaving you to discover it. If we genuinely cannot fill it, you hear that early enough to use your own contingency plan, because for this kind of care a late notification is the failure.

Is any of this publicly funded?

Often a substantial part of it. Ontario Health atHome arranges publicly funded nursing for people who qualify, and the equipment side runs through the Assistive Devices Program and the Ventilator Equipment Pool. Start there before paying privately.

Do you do this for children?

Yes — see nursing at home for children with complex medical needs, which covers the paediatric version including trachs, ventilators and G-tubes.

Where we provide this care

We provide this support across 146 communities in Ontario, from the Greater Toronto Area to Thunder Bay. If your town is not listed, call us — we will tell you honestly whether we can staff it properly rather than promising and then failing to turn up.

Related

• Children with complex medical needs
• COPD and respiratory care
• ALS
• Muscular dystrophy
• Spinal cord injury
• 24-hour home care
• Overnight care