Abstract Summary Mechanical ventilation is increasingly used in the home setting to provide long-term respiratory support for selected patients with chronic type 2 respiratory failure. Non-invasive ventilation (NIV) via a mask is usually only required during the main sleep period for the majority of patients, including those with respiratory failure due to chronic obstructive pulmonary disease, obesity, and scoliosis. Some with progressive neuromuscular conditions, such as motor neurone disease, may use NIV overnight initially though later may benefit from more continuous use. A smaller proportion of patients within some home mechanical ventilation services (HMVs) may require intermittent or continuous support of ventilation via a tracheostomy tube. Treatment aims and approaches are therefore tailored to an individual’s needs, from overnight support using a simple home ventilator to the provision of full life support at home using dedicated equipment and a trained care team. HMV services have expanded as the evidence base has grown. Like all technologies, ventilators are ever-evolving via newer modes of ventilation subject to ongoing research. The increasing ability to monitor ventilation use remotely via telemonitoring can enable HMV services to troubleshoot some issues without face-to-face attendance. While further research is needed, future optimal pathways are likely to comprise a blended combination of remote and in-person management, individualized according to patient wishes and need.