Respiratory impairment not only affects the patient but also the patient’s family and social network, particularly when the patient is at home. The underlying disease and the individual clinical picture determine decisions on long-term respiratory care, whether to proceed with comfort care or support quality of life. Patients may depend on intermittent or continuous mechanically ventilation but may also simply carry a tracheal cannula for endotracheal suctioning. In any of these cases patients need out-of-hospital intensive care by professional or family caregivers. Caregivers require wide-ranging structures of support in order to fulfill their tasks and meet the expectation placed on them. This chapter discusses models of support and explores the multifaceted challenges caregivers of home mechanical ventilated patients must face; it highlights the basic skills, challenges and support systems that are essential for the care experience of patients ventilated at home.