Nebraska Strives To

Care For

Ventilator-Dependent
Children At Home

As a medical director of Services
for Crippled Children in Nebraska,
| would like to educate you as to
what services are available. May-
be this will give us a springboard
as to what other things can be ac-
complished nationwide.

Crippled Children’s programs in
Nebraska were expanded a great
deal under the governorship of
J.J. Exon, who is now a senator.
He and his wife were very, very in-
terested in chronically disabled
children, and through his efforts,
our budget was increased con-
siderably and a lot of categories
were included in our program
which were not in the program be-
fore.

We have a unique position in
Nebraska where all children who
are provided any care under 94142
are coordinated through Services
for Crippled Children. So, every
child who is disabled in the state
of Nebraska has a record in my
office, whether they are eligible
financially for aid from Crippled
Children’s or not. We are basically

by Dale Ebers, MD

constituted to provide help for the
medically indigent family — notthe
indigent family. The medical costs
of some of these diseases and con-
ditions can be horrendous — you
can run through thousands of dol-
lars so fast you can't believe it.
If the family or patient is Medicaid
eligible, we ask Medicaid people
to do the financing, and we do the
case management. [n that way, we
have more uniformcontrol overthe
quality of care that is delivered,
regardiess of where that delivery
is made in the state.

We hold the basic premise that
all children should be cared for at
home, or as close to home as pos-
sible. That is probably a personal
bias that | hope is reinforced in
the state.

We have enlarged the area of
hyperalimentation. Hyperalimen-
tation means there is a permanent
central line into the cardiovascular
system, which creates a great pos-
sibility of infection. Eighty percent
of the kids who are on a program
for hyperalimentation have a short

bowel syndrome or intractible
diahrrea and are usually between
6 and 18 months of age. Dr. Van-
derhoff, who trained at UCLA and
came back to Nebraska and wanted
to get into this, came to me and
asked if Crippled Children’s could
support this program in the hos-
pital. We discussed the problem
and decided we would have to find
a way to do treatment at home.
Vanderhoff has accomplished this.
He developed protocol and he has
a nurse who spends about a week
teaching parents how to prepare
the solutions for treatment. She
then supports them at home by
visiting or calling once a day for
the first few weeks, and then vis-
its once a week. Vanderhoff usu-
ally sees them once a month. The
program’s been going on for about
three years now, and this past
year it cost $100,000. If you would
have had those kids in the hospital,
we would have been spending in
the range of half a million dollars.
Obviously, that is a very cost ef-
fective procedure. @ ,

Dale Ebers, MD, is medical director for Services for Crippled Children, State of Nebraska, in Lincoln, NE.

 

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