Complex Medical …a difference

For years I have been trying to explain the gap between “licensed care” and truly understanding a medically complex human being. 

 Yesterday, our respiratory therapist from the DME company(home medical supply company)we use was here again. She comes once a month to check Alex’s equipment. But honestly, what they provide is far beyond “equipment checks.” This company was founded specifically to serve people with complex medical situations.

 Their therapists are required to have intensive care experience. They understand that ventilators are not just machines with settings written on a piece of paper. They understand there is a human being attached to that ventilator. 

 Years ago, we switched to this company after Alex’s suction machine stopped working correctly. I tried to get the previous company to replace it, but they said they could not provide one. The suction machine is used to clear a person's airway when they are unable to themselves. It’s a crucial piece of equipment in the lifesupport system. I called this new company and spoke with one of the founders. Within an hour and a half, a new suction machine was sitting on our doorstep — and we live an hour from Columbus. 

 That moment told me everything about the difference between task-based thinking and true understanding. One system thinks:“Submit a work order.”“We’ll check next week.”“Put it in the queue.” The other system thinks:“What happens to the person if this fails?” That is the difference. 

 The respiratory therapists understand things happen at ALL hours of the day and night. They understand medically complex situations are not cookie cutter. They understand that changes in breathing, equipment function, skin color, communication, temperature, positioning, or subtle distress signs may mean something significant is happening physiologically. 

 That type of thinking is very different from many of the experiences we have had with homecare staffing systems.  

As I’ve continued trying to understand how agencies become qualified to provide “skilled” services, I’ve learned something important. In Ohio, the Ohio Department of Health certifies home health agencies under federal CMS standards. But the state is largely checking: policies, documentation, staffing structures, compliance, supervisory requirements, and training records. 

 The actual determination of whether a nurse is considered “competent” for a specific medically complex case is often made internally by the agency itself. That means a nurse may legally hold: a nursing license, ventilator documentation, and competency sign-offs, without necessarily understanding: high cervical spinal cord injury physiology, autonomic dysreflexia, diaphragm pacing, individualized respiratory patterns, or the subtle warning signs unique to a particular person. 

 And that is the gap I keep trying to explain. A license alone does not automatically equal competency for a highly individualized, life-threatening situation. The system often assumes: shifts are interchangeable, tasks are transferable, and any licensed person can simply “step in.” But medically complex homecare often depends on: continuity, pattern recognition, individualized responses, and understanding the person, not just the task list.

 The respiratory company we use understands this. Their entire culture is built around understanding what happens to the human being if something fails. Too often, other systems are built around whether the form was completed.  

That difference can become life or death. 

 * High Acuity Home Care * Complex Medical Care * Home Ventilator Care * Spinal Cord Injury * Diaphragm Pacing * Disability Advocacy * Medicaid Waiver * HCBS * Home and Community Based Services * Skilled Nursing * Respiratory Therapy * Autonomic Dysreflexia * Homecare Policy * Medical Complexity * Caregiver Advocacy * Person-Centered Care * Ohio DODD * Ventilator Dependent * Continuity of Care * Disability Rights