Nutritional Support at Home

With the escalation of costs of hospitalization, home infusion companies have blossomed, allowing us to discharge patients early to continue interventional feeding safely and more comfortably in the home environment. First, it started with home parenteral feeding (HPN) for patients with permanent intestinal failure, where the objective was to return patients to as near normal a lifestyle as possible. Next, it expanded to include home enteral feeding and patients with PEGs. Most recently home enteral feeding (HEN) has broadened to include nasoenteric tube feeding for a variety of conditions, for example patients with upper GI obstruction waiting for spontaneous resolution or surgery. The procedure for HPN or HEN is similar: first establish the nutritional intervention in the acute hospital setting, then train the patient and his/her spouse or home care-giver how to manage the infusions, and finally team up with a commercial home-care provider to supervise the infusions and provide the products. A variation of this will include the aged and infirm who need assisted living or nursing home support where patients and spouses are less able to manage the feeds.