Invasive HMV is arguably one of the most complex respiratory services delivered in the home. In contrast to many other home-care services, invasive HMV requires much more advanced decision making, planning, training, and oversight. Highly effective hospital discharge planning that includes well-choreographed interdisciplinary support is essential for long-term success.20Physicians, nurses, professional therapies, home respiratory therapists, insurance case manager and, most importantly, family/caregiver acceptance, and buy-in are key components of any VAI home transition and management plan. For many families, especially new parents and elderly spouses dealing with a medically fragile loved one, this training and transition process can be very traumatic and frightening.21–22 Despite the frequent administrative pressures to expedite the process, there must be adequate time for effective caregiver training, the preparation of the home environment, and the coordination of care among the various agencies. For many Medicare-aged adult patients, the primary caregivers are often the spouse and immediate family, with very limited professional support from home health agencies or other medical professionals. In the pediatric VAI population, the ability to provide more technically complex care in the home is often supplemented through professional, private-duty caregivers who are funded by third-party payors, including programs such as the Medicaid medically fragile waiver programs. In all cases, it is extremely important to respect and appreciate the needs of the patient, the caregivers, and the team members responsible for the care of the patient once they leave the safety and comfort of the institutional setting.