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Hi it’s Patrik Hutzel from INTENSIVE CARE AT HOME where we provide tailor made solutions for long-term ventilated Adults & Children with Tracheostomies and where we also provide tailor made solutions for hospitals and Intensive Care Units whilst providing quality services for long-term ventilated patients and medically complex patients at home.
In last week’s blog, I talked about,
HOW TO SELECT SERVICE PROVIDER WHEN YOU NEED INTENSIVE CARE AT HOME?
You can check out last week’s blog by clicking on the link below this video:
https://intensivecareathome.com/how-to-select-service-provider-icah/
In today’s blog post, I want to answer a question from one of our clients and the question today is
10 things That Need to be in Place Before Intensive Care at Home!
Good morning. Good afternoon. Hello everyone and welcome to another YouTube live stream from Intensive Care at Home and Intensive Care Hotline. My name is Patrik Hutzel from Intensive Care at Home and Intensive Care Hotline and in today’s live stream, I want to talk about 10 things that need to be in place before intensive care at home can happen.
So before I dive right into it, you might be wondering, what makes me qualified to talk about this topic and just want to quickly talk about what I’ve done to this point. I’m a critical care nurse by background. I’ve worked in critical care for over 20 years in three different countries, and I also have a lot of experience with Intensive Care at Home services.
I was part of setting up Intensive Care at Home services in the early 2000s in Germany and I have also set up Intensive Care at Home successfully here in Australia. And we are now trying to branch out into other countries, including the UK and the United States and Canada. It’s not there yet, but we are successfully operating Intensive Care at Home nursing in Melbourne, Australia, as well as in Sydney, Australia and we’re now starting in Brisbane as well.
As part of my intensive care nursing experience, I worked as a nurse unit manager for over five years and I worked in a range of intensive care settings, as I said, worked with Intensive Care at Home and still working with Intensive Care at Home. I worked in trauma ICU, cardiac ICU, general ICU, neuro ICU, but also in pediatric ICU. So I have a wide range of experience as part of my work in intensive care.
Now, in today’s topic again, I do want to talk about 10 things that need to happen or need to be in place before Intensive Care at Home can happen. And I want to dive right into it. Please ask questions as we go along, type them into your chat pad, and maybe at the end of the live recording, if we still have time, maybe you can also call me and I’ll give you my phone number and at the end of the call, and maybe you can call me even on the live stream. So we can then answer your question on the live stream.
So let’s dive right into the 10 things that need to happen before Intensive Care at Home can happen. So let’s just look at the conditions that we are predominantly looking after with Intensive Care at Home, and let’s break this down. So, the most common clients we are looking after at home for Intensive Care at Home is somebody that’s on a ventilator with a tracheostomy, that is bread and butter for us.
Those are the most clients we’re looking after. It’s someone that has spent weeks, sometimes months in intensive care. They’re unable to come off the ventilator. They’re unable to have the tracheostomy removed and then they can continue intensive care in the home because those patients have nowhere to go to. They can’t go to a hospital ward. They can’t go to a hospital floor.
In the United States, if you’re watching this and you are in the United States, they can often go to LTAC. But you might have heard me say this before, LTACs are just a disaster area. They’re a better version of a nursing home, and it’s just a disaster waiting to happen at LTAC.
Here in Australia, obviously, if patients are stuck in intensive care on ventilation with tracheostomy, they can go home with our service, Intensive Care at Home, and we can continue with intensive care level treatment at home on a nursing level, or we can potentially wean them off the ventilator at home. We’ve certainly done this successfully and we’ve also had patients successfully decannulated at home from the tracheostomy, and then they get discharged from our service, which is a massive success.
Other clients we are looking after at home are for example, patients that are on BIPAP and CPAP ventilation. They’re not having a tracheostomy, but they’re BIPAP or CPAP ventilated. Clients like that include patients or clients with cerebral palsy, for example, but we’ve also got clients with sleep apnea and they have other medical conditions. There might be dementias as well. So there’s a number of conditions that can lead to BIPAP or CPAP ventilation. Also COPD (Chronic Obstructive Pulmonary Disease) of course, asthma can be part of needing BIPAP and CPAP as well. Just quickly going back to mechanical ventilation and tracheostomy at home, conditions that we are seeing for our clients are C1 spinal cord injury, C2 spinal cord injury and the like, motor neuron disease, sometimes we have people with Guillain-Barré syndrome, also other neurological conditions that lead to long term mechanical ventilation and tracheostomy.
Next, we also have clients at home that are not ventilated, but have a tracheostomy. So, there’s many people living in the community with a tracheostomy but are not ventilated. Some of those clients need a cough assist machine, for example, but they’re not ventilated all the time like most of our other clients with ventilation and tracheostomy. Some of our clients on BIPAP and CPAP also might need a cough assist. A cough assist machine is basically a machine that delivers a PEEP, a high PEEP, sometimes 25 up to 35, and then also delivers a negative PEEP. And it makes people cough. It inflates their lungs and it makes cough. It clears the airway, it clears the secretions, keeps the lungs expanded. It’s very effective. And we’re using that for quite a few of our clients in the community.
Next, we’re looking after clients at home with TPN. TPN stands for Total Parental Nutrition, those clients so far that we’ve looked after are not ventilated. They don’t have a tracheostomy. They’re usually not on BIPAP or CPAP, but that doesn’t mean that we couldn’t look after someone on TPN that has ventilation, has tracheostomy. So we could do a combination of that of course, but the clients we looked after so far at home on TPN or Total Parental Nutrition are not ventilated.
Now, why are they looked after by a service like Intensive Care at Home? Quite simple, TPN requires a central line, a PICC line or a Hickman’s line and in order to manage TPN sterile, in order to manage the Hickman’s line, the central line or the PICC line sterile, you need the skills of a critical care nurse in the community to keep clients at home. Now just quickly, TPN is also known as intravenous nutrition. Most of those clients can’t take food in orally. They can’t have food via nasogastric tube, PEG tube or PEJ tube. That’s why they are on TPN.
And last but not least, we also have clients at home that are actually not ventilated at all, but that are medically complex and still need an intensive care nurse 24 hours a day. For example, we have some clients again with very rare neurological conditions, including but not limited to, Cerebral Palsy, Rett syndrome and they have regular seizures, regular grand mal seizures. And again that, especially in the home care environment, needs the attention of an intensive care nurse. Clients often start vomiting. Their airway becomes unstable. They are at aspiration risk. They do often aspirate. And again, in order to manage the airway safely, they need the skills of a critical care nurse. They often stop breathing. We then deal with that with medication management, often diazepam, midazolam, that obviously impacts on their airway as well. And then we might need to use Guedel airways, nasopharyngeal airways. We might need to use resuscitation bags to manage the situation and keep clients at home safely, even though they’re not ventilated and they don’t have a tracheostomy. Our goal is always to prevent intensive care admissions. That’s why we are bringing the intensive care service into the home. So that’s it in a nutshell what type of clients we are looking after at home.
I believe that one of our next steps as a service provider is that we will be also looking after clients at home with low doses of inotropes or vasopressors such as noradrenaline, norepinephrine, epinephrine or adrenaline, dobutamine, dopamine, milrinone, that I believe can be done at home as well, but it’s probably not quite there, but if you have a family member in that situation, you should definitely contact us and we can see how we can help you and what other resources we need to put in place to take your loved one home safely.
So also other clients that we looked after at home, we looked after palliative care clients at home, we have provided palliative care or end-of-life care at home for people on ventilation, tracheostomy. We have also done what’s called a “one way extubation”, that basically means the removal of a breathing tube for an end-of-life situation. We’ve done that at home too. So there’s a variety of things that we can do at home that can be done in intensive care as well. And we are just providing that safely in a home care environment.
We are an accredited healthcare service. We have third party healthcare accreditation for Intensive Care at Home services. And we are also here in Australia, NDIS (National Disability Insurance Scheme) accredited and we are working with the TAC, the Transport Accident Commission. We are working with iCare in New South Wales and the DVA, the Department of Veteran Affairs. That leads me to the next point, which is funding. Funding needs to happen. Obviously an intensive care bed costs around 5000 to 6000 dollars per bed day. That’s a lot of money. And if you look at the current environment where ICUs are full of COVID, nobody wants to be in the COVID ICU. The risk is very high for people to contract COVID.
So the home care environment is a much safer environment. It’s also much less risky in terms of infection at home. So there’s much less risk for COVID exposure at home than there is in an ICU. And if you have a family member in ICU on a ventilator, they’re very vulnerable, you need to get them out there as quickly as possible.
So coming back to the funding side of things, as much as I want to talk about clinically today, but I also believe it’s very important for you to understand the economics of things. Again, intensive care bed, 5000 to 6000 dollars per bed day. And that’s the same, whether it’s in the US or here in Australia. In the US, it’s 5000 to 6000 US dollars. Here in Australia, it’s about 5000 to 6000 Australian dollars. We can cut that cost by around 50%. Now, if you think about this, wouldn’t that be appealing for any funding body to slash the cost of their highest cost bed in a hospital by 50%?
You think that makes sense. You think that’s a no-brainer. I guess, with anything in healthcare, the funding side of things can be challenging at times, but just on an economic level, think about this, we’re cutting the cost of an intensive care bed by 50%. You, as a family, you want to go home, you want to have your loved one home. The ICU wants the bed. The ICU needs the bed to free up capacity for the next patient. And they need to free up staff, need to free up equipment, and we’re cutting the cost of the ICU bed. It’s a no-brainer. It’s an absolute no-brainer on an economic level.
But for you, I presume you are watching this because you have a loved one in intensive care, or you might be at home already, but you don’t have the support that you need. You’re looking for intensive care nurses at home, whatever your situation may be, the funding shouldn’t stop you from pursuing getting your loved one out of intensive care. You just need to know the mechanics because it helps you with your argument. And we can certainly help you with the argument. We’ve done so much advocacy for families in intensive care and outside of intensive care to help them with getting Intensive Care at Home and make their lives safe.
Now, with funding as well, if you’re watching this in Australia, if you’re below the age of 65, you’re entitled to the NDIS funding. If you are in Victoria, depending on the situation, if you had an accident, you might be entitled to work safe or TAC (Transport Accident Commission). If you are a veteran, you might be entitled to DVA (Department of Veteran Affairs) funding. We’ve worked with all of those funding bodies, but more importantly, we’ve also received funding through hospitals directly, because again, it saves them 50% of the cost. We’ve also received funding through the Department of Health.
So, the funding is there. It’s just a matter of accessing it and getting the advocacy right. I’ll come to our US audience and how we can go about funding there a little bit later, I just want to move on as we speak.
What needs to happen next is equipment. At Intensive care at Home, you need to replicate at home what happens in an intensive care unit. And in order to do so, part of it is obviously intensive care staff, but you also need the equipment ventilator, tracheostomy, spare tracheostomies, tracheal dilator, resuscitation bag, potentially infusion pumps, monitor. You need a whole range of things and I’m not going down the whole list. We can set it up where you need probably a hoist or a lifting machine. You probably need a special hospital bed. It’s a number of things you will need, but nothing that can’t be overcome. Even if you’re now thinking, “Oh, is my home suitable for Intensive Care at Home?” I can tell you we’ve worked in small places, in small houses, and it’s all possible, as long as you talk to us and we can look at your situation and get it little bit creative, it’s all possible.
Next, what needs to happen next is you need a team and that’s possibly one of the most important things for you, because you want to feel comfortable with the people that are coming into your home. I mean, you probably know that already from a hospital environment already that some nurses you like, some nurses you don’t like, some doctors you like, some doctors you don’t like, and it’s critically important that in a home care environment, we can match you with the right intensive care nurses that you feel comfortable with. Because at the end of the day, it’s all about you taking control. It’s your environment. You want to run your show. You want to run your routine embedded in your day-to-day life with your family. And we understand that’s very important. And we are also understanding that to make this happen, you need the right people on the team and that can take sometimes a little while to match the right staff with you and your family. We understand that. But you need 24-hour nursing care for all of the situations that I mentioned before. And we often work in 12-hour shifts, but sometimes we also work in three shifts a day like eight hour shifts, really depends on your, again, your situation, depends sometimes on staff availability.
The only exception to that is that sometimes when people are on BIPAP, CPAP only overnight, and they don’t need it during the day, you may not necessarily need an intensive care nurse during the day. Same with TPN, you really only need the intensive care nurse when the TPN is running. On the note of TPN, I should also say we also provide IV (Intravenous) therapy at home whether its IV infusions, or whether its IV antibiotics. Again, talk to us if that is part of your requirement.
We also always advocate for a team leader when we have a 24-hour roster. It’s very important that you steer, that someone can actually lead the team, oversee the day to day care, liaise with doctors, with other services, external appointments, outpatient appointments and so forth. So that’s all doable how a team leader helps.
The other thing that I haven’t mentioned in the beginning that just comes to mind now, we can also do dialysis at home of course, we can do it for patients with ventilation, patients without ventilation, but we can certainly also do home dialysis when needed. So, that’s the team.
Next, you need evidence-based care. Now, you might have heard me say this before, like in a hospital, for example, everything is evidence-based. Everything is evidence-based. And there is now enough evidence about Intensive Care at Home and what resources need to be in place to take someone home from ICU on a ventilator in particular. And we have published on our website, the mechanical home ventilation guidelines, and those guidelines are a result of 25 years of research predominantly from Germany where Intensive Care at Home has been around for decades now and the research has clearly shown that you can only take a patient home from intensive care with a team of intensive care nurses where each of those team members has a minimum of two years intensive care experience. And that is the bottom line. You definitely want to have evidence-based care.
We are well aware that some service providers out there look after ventilated patients at home with support workers or with general nurses without ICU experience or even enrolled nurses. And that’s quite frankly dangerous in my mind, that is a criminal act because you wouldn’t take someone off the street, sending them into ICU and look after a ventilated patient. So why would you do that in the community?
Just because there’s no lobby, that’s the question that I’m asking, but the bottom line is this, you want evidence-based care because if you’re not getting evidence-based care, we have seen numerous examples where unfortunately, patients at home that do not have intensive care nurses 24 hours a day, if they’re ventilated or if they have a tracheostomy, they die. And I’m not exaggerating here. We’ve got evidence that we had some clients where there was only funding for night shift and those clients were either having a ventilator or a tracheostomy. And we were warning the funding body saying, look, you’ve got to fund 24-hour nursing care because the minute we leave, the client is at risk and could potentially die.
Unfortunately, this became a reality that two of our clients passed away. We were only funded for night shifts and both of those clients had passed away during daytime when either support workers or general RNs or the family could not manage a medical emergency with a tracheostomy. And that’s simply deadly. You can’t, not have evidence-based care at home. You can’t, not have intensive care nurses at home that can manage tracheostomy and ventilation safely, and that can manage a medical emergency should it happen, God forbid.
Next, you need a care plan. You need a care plan, the care plan often comes from the hospital with instructions, what needs to happen at home, but then you also need the nursing care plan that we can help you with by the time you’re going home. The care plan often gets reviewed on a regular basis. Of course, things change and then the care plan needs to change, needs to be adapted on a regular basis. Sometimes ventilation settings change. Sometimes the frequency for suction changes, sometimes the routine changes. Sometimes there may be a pressure sore. There may be issues with tracheostomy side. There may be issues with the PEG side, whatever it is, a care plan needs to be updated regularly. Sometimes there may be changes with medication charts, could be all sorts of issues that need to be reviewed on a daily or weekly basis as part of the care plan and as part of the multidisciplinary team planning.
Now, I also want to quickly talk about the support coordination that especially our viewers in Australia need. So especially if you come in under the NDIS, you will need a specialist support coordinator to get the funding in place, and you should be contacting us for the specialist support coordination. We are providing that in-house or we can provide it in-house and it’s necessary for the advocacy side of things. Otherwise, the NDIS or other funding bodies will not give you what is evidence-based. So you should definitely contact us when it comes to the funding side of things.
For our viewers in the United States or in Canada, again, we are not in the United States or Canada yet, but if you do have a situation where you think you qualify for Intensive Care at Home, you should contact us anyway. We can help you with consulting and advocacy in intensive care. And we might also be able to point you in the right direction to some service providers in the US. There are not many, it’s such a specialized area. I don’t know many service providers that can do what we can do. Just simply, it’s a very specialized area. You need the right staff, you need the right mindset. You need the right intellectual property, i.e., policies, procedures, quality manual. And that’s what we’re working with. We have built the intellectual property to make Intensive Care at Home a reality and make it safe.
And the same in the US or in Canada, whoever’s funding healthcare, again, it’s a case of making the economic argument. We are cutting the cost of an intensive care bed by 50%, we are freeing up your ICU bed that you need, and we’re freeing up the staff that you need. We’re freeing up equipment. Again, it’s all about creating that win-win situation.
And if you are in the United States and you want Intensive Care at Home, please contact us because if you are in a certain location where we think we can help you, we will. So please contact us irregardless, because we definitely want to help you. And again, we have some contacts, if we can’t provide the service ourselves yet, we hopefully can point you in the right direction. And again, at the very least, we can help you with consulting and advocacy while you’re in intensive care.
So then I also want to open up the floor to questions. If you have any questions, please type them in the chat pad, or you can also call me in. You can also call me live on the show. I’ll give you my number. If you’re in the US, you can call me on 415-915-0090, that is again for our US North American audience, 415-915-0090. I can let you in on the call and for our Australian viewers, you can call me on 041-094-2230, that is again, 041-094-2230. And I can get you live on the show and answer your question, if you’d like.
Just quickly coming back to Intensive Care at Home while I’m waiting for your question, it’s also a case of how do you make Intensive Care at Home safe? As I said to you, intensive care nurses are overseen by a medical team, but also having the right equipment. But more importantly, having the right mindset. Our KPIs are, KPI stands for Key Performance Indicator, to keep all clients at home at all times. We don’t want to have any non-elective readmissions back to ICU. And obviously we want to have all shifts filled. That’s very important for us to have all shifts filled that prevents hospital readmissions. So you can get on with your life. Your loved one can get on with their lives and so forth.
I also want to quickly address families who have a loved one at home already, and don’t have 24-hour Intensive Care at Home, because they’re potentially having a provider at the moment that doesn’t know how to get intensive care nursing’s funding, that doesn’t even know that this is an option, that doesn’t even know that the support they’re having is probably inadequate and puts their loved one’s life at risk.
You should definitely reach out to us. We have helped many families going from support worker funding or general registered nurse funding to Intensive Care at Home funding, which is at the higher level, but it’s also the higher level service you need, especially when it comes to all the conditions that I mentioned, ventilation, tracheostomy, BIPAP, CPAP ventilation, TPN and any other medical complexities.
Helene, you’re asking, what about the evidence-based was iatrogenic’s causation, malfeasance, drug manipulated injured, massive amount of opioids? Not exactly sure what you mean, Helene. Causation. Yeah. Any evidence in a hospital Helene, you need to give us access to the medical records so we can look at the evidence and then get back to you. So the best next step there, Helene is send me the medical records and send that email to [email protected]. And then I can get back to you, how much time we need for the review. And then hopefully we can get your question answered.
So then quickly coming back to families that are at home already and they don’t have enough support. Maybe their loved one is bouncing back to ICU all the time or bouncing back to hospital. Again, this is where we can help. This is where our area of expertise is to keep intensive care patients at home predictably so that it’s a win-win for everyone. Win for you as a family, win for the client, win for the hospital, win for the funding body and also a win for us, of course. It’s all about creating win-win situations.
So if there are no other questions, I am conscious of the time and I hope that was helpful today. I hope it answered some of your questions. Check out intensivecareathome.com for more information. Again, you call me on one of the numbers on the top of the website, or send me an email to [email protected]. That’s Patrik, just with a K at the end.
Now, if you have a loved one in intensive care and you need help, generally speaking, contact us as well, not only for the home care side of things, we can help you with the consulting advocacy side of things in intensive care as well while you’re getting ready for home care. Again, you can also check out Intensive Care Hotline for that.
If you like this video, if you see any value in it, please give it a thumbs up. Click the notification bell, subscribe to my YouTube channel for updates and live streams for families in intensive care. And also, leave your comments below what questions and insights that you have. Then we can go from there.
Now, I assume there are no further questions. I haven’t heard anything else. Nobody’s called me on the phone and that’s fine. I shall see you next week again at the same time, 7:00 PM Eastern standard time, 4:00 PM Pacific time on the Saturday, 11:00 AM Sunday, Sydney, Melbourne time, 10:00 AM Brisbane time. That’s where we are next Saturday/Sunday, 30th, 31st of October. And I’ll talk to you then.
Take care for now and thank you so much for all your support and for spreading the word. Share this video if you like with someone that you think that needs to know this information.
Take care for now.
Now, if you have a loved one in intensive care and you want to go home with our service Intensive Care At Home and if you want to find out how to get funding for our service and how it all works, please contact us on one of the numbers on the top of our website, or send me an email to [email protected]. That’s Patrik, just with a K at the end.
Please also have a look at our case studies because there we highlight more about what we can do for clients, how clients can live at home with ventilation and tracheostomies and you can look at our case studies as well at our service section.
Intensive Care At Home Case studies
And if you are at home already and you need support for your critically ill loved one at home, and you have insufficient support or insufficient funding, please contact us as well. We can help you with all of that.
And if you are an intensive care nurse or a pediatric intensive care nurse with a minimum of two years, ICU or pediatric ICU experience, and you ideally have a critical care certificate, please contact us as well. Check out our career section on our website. We are currently hiring ICU and pediatric ICU nurses for clients in the Melbourne metropolitan area, Northern suburbs, Mornington Peninsula, Frankston area, South Gippsland, as well as Wollongong in New South Wales.
www.intensivecareathome.com/careers
So we are also an NDIS, TAC (Victoria) and DVA (Department of Veteran affairs) approved community service provider in Australia. Also have a look at our range of full service provisions.
Also, we have been part of the Royal Melbourne health accelerator program in the past for innovative healthcare companies.
https://www.thermh.org.au/news/innovation-funding-announced-melbourne-health-accelerator
https://www.melbournehealthaccelerator.com/
Thank you for watching this video and thank you for tuning into this week’s blog.
This is Patrik from Intensive Care At Home, and I’ll see you again next week in another update.