Describing the scope of long-term mechanical ventilation in complex continuing care: An Ontario survey and future recommendations

RATIONALE Specialized long-term ventilation (LTV) units within Ontario’s complex continuing care (CCC) sector relieve critical care pressures but have developed heterogeneously, lacking standardized guidelines for admission, care and resource allocation. This variability contributes to regional disparities in access and care quality. Characterizing current practices is essential to inform provincial standardization.OBJECTIVES The objectives of this study were to describe patient profiles, care models, staffing and resources across Ontario’s LTV programs serving adult CCC patients and provide recommendations for standardization of care across the province.METHODS A cross-sectional electronic survey was distributed to clinical managers and program directors at all 10 Ontario LTV sites (June–August 2025). The 40-minute, 95 item instrument examined admission criteria, program structure and staffing models.MEASUREMENTS AND MAIN RESULTS All sites participated (100% response; 202 beds). Clinical stability was required for admission but variably defined (mean 8.9 ± 6.2 days; range 2–21). Advanced care planning was universal, with consistent palliative care access. Service availability varied: all offered pharmacy, palliative care, and speech language pathology; 90% physiotherapy/occupational therapy; 30% psychology, cardiology, or ENT specialists. The median (Q1, Q3) number of registered nurses scheduled per shift was 3 (2, 4) days, 1.75 (0, 3) evenings and 3 (1, 3) nights; the median (Q1, Q3) number of registered practical nurses scheduled per shift was 6 (5, 7) days, 3.5 (0, 6) evenings and 3 (2, 4) nights. Only 50% had 24-h respiratory therapy coverage. Physician models were mainly hospitalist/family physician led (80%) with limited specialist support (40%). Transition barriers included equipment access and caregiver support.CONCLUSIONS Ontario’s LTV programs show heterogeneity in clinical practices, staffing, and services. Findings provide foundational data to guide standardization of admission criteria, resource allocation, and quality metrics province wide.