For both developed and developing countries in the world, the twenty-first century will be marked by great challenges for healthcare systems. The overwhelming reason will be aging societies that will face an increase in multimorbid, chronic diseases which will include neurological diseases. The probability of surviving acute illness and the medical opportunities to prolong life in chronic-progressive disease will improve in future. As a result the numbers of neurological patients with respiratory impairment caused by prolonged, chronic or chronic-progressive life-threatening disease will increase. Minimizing dependency on life-supporting technologies and care, stabilizing vital functions, optimizing quality of life and participation and alleviating suffering are paramount goals for these patients. The therapeutic approach therefore must integrate intensive care, neurorespiratory care, rehabilitation and palliative care. Furthermore, patient-centered and family-oriented care, which covers the whole lifespan and bridges the gap between inpatient and outpatient care, is needed.