Present-day technology has made the in-home care of patients requiring prolonged mechanical ventilation increasingly common. When this technology is applied to the care of patients with amyotrophic lateral sclerosis, physiological, psychological, and ethical issues must be adequately addressed. Assessment of medical and social factors in six patients, four of whom are still living, indicates that in-hospital as well as follow-up evaluation should be carried out in an effort to anticipate the long-range problems, challenges, and limitations of home care ventilation. Because of increasing availability and simplicity of portable respiratory support devices, the implications of long-term ventilatory support for some patients with amyotrophic lateral sclerosis and similar illnesses will become more commonly considered in planning long-term home care.