My understanding as a hospice volunteer is that having a ventilator requires 24 hour care by a professional nurse because it is not something a wife can deal with. You might recall that when Christopher Reeves fell from the horse and was paralyzed, he was immediately put on a ventilator to save his life, but ever-afterwards he required a full time nursing staff/facility. This was NOT simply a luxury because he was a wealthy actor, but part of a larger problem.
My ALS patient has decided he will die naturally when he needs a ventilator because having a ventilator automatically disqualifies the family from hospice care. Instead, he would have to be in a private nursing facility, with estimated costs of $250,000 per month, much that would not be covered by insurance.
Now, I urge you to research this on the internet, talk to your doctor, your insurance company, etc., because my understanding is that going on a ventilator is a HUGE DECISION for an ALS patient, because it has HUGE financial and quality of life implications. It is not a simple thing!
My poor patient does not want his family to go through the agony and expense of having him in a private facility the rest of his life (which could be extended a long time with ventilation) so he has (pretty much for economic reasons and quality of life considerations) decided to "check out" when a ventilator is needed. This is courage and love at a magnitude I've never encountered before.
Having ALS and being a caregiver take insatiable amounts of courage and love. Don't try to do it alone.