When The Hospital Becomes Home Ventilators Can Keep Some Patients Alive, But The Technology Can't Help Them Return To Productive Lives.

The days vary little for Joseph Bingham, 73, a long-term ventilator patient in the University of Pennsylvania Medical Center.

A double amputee with emphysema and bronchitis, Bingham spends his days sitting in a wheelchair in the doorway of his room, alternately dozing and watching the staff hurrying by. He's fully alert, but has difficulty talking

because doctors have cut a hole in his throat for the ventilator tube that

keeps him alive.

Bingham has been living there like this for almost three years.

His life is not much different from that of Gladys Holmes, 86, a long-term ventilator patient in Graduate Hospital.

Holmes, who like Bingham has severe lung disease, spends her time in a chair watching television dramas and being fussed over by nurses who have come to look upon her more as a beloved grandmother than a patient.

Holmes has been in this room, attached to a ventilator, for almost four years.

The local record breaker for adult chronic ventilator patients is Raymond Steinmetz, 38, who is totally paralyzed by Duchenne muscular dystrophy.

Unable to move any muscles - even his respiratory muscles are wasted - Steinmetz spends his days propped up in a chair watching any sporting event that happens to be on television.

Steinmetz has lived like this in Brandywine Hospital and Trauma Center, tethered to a breathing machine, for four years and seven months.

Steinmetz, Holmes and Bingham are dramatic illustrations of halfway medical technology, therapy good enough to keep patients alive but not good enough to return them to fulfilling, productive lives.

It is a problem that is becoming increasingly common as the population grows older and medical science becomes more adept at keeping patients with otherwise lethal impairments alive.

Some of these patients, with large and capable families, are being sent home on their ventilators, tended to by family members with the assistance of home-care nurses and respiratory therapists. Others, with extensive private insurance, are being cared for in the handful of nursing homes capable of supporting such patients.

But many of the patients never leave the hospital even though they no longer need acute care. Instead they linger in beds costing $500 to $1,000 a day until infection or the underlying disease that put them on the machine in the first place kills them.