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My name is Patrik Hutzel from intensivecareathome.com  where we provide tailor-made solutions for long-term ventilated adults and children with Tracheostomies, where we provide tailor-made solutions for long-term ventilated adults and children on BiPAP (Bilevel Positive Airway Pressure), Home CPAP (Continuous Positive Airway Pressure) ventilation at home, where we provide tailor-made solutions for tracheostomy, adults and children in the home without ventilation. We provide ventilation weaning, tracheostomy weaning at home wherever medically appropriate. We provide home cough assist management, Home TPN (Total Parenteral Nutrition), home IV fluids, home IV antibiotics, home IV potassium, magnesium, and other electrolyte infusions.

 

We provide central line, PICC line, Hickman’s line, port management. IDC, SPC, PEG (Percutaneous Endoscopic Gastrostomy), PEJ (percutaneous endoscopic jejunostomy) tube, as well as nasogastric and naso jejunostomy tube at home. We also provide palliative care services at home, as well as Level 2 and Level 3 NDIS (National Disability Insurance Scheme) support coordination, as well as TAC and WorkSafe case management.

 

Every week I speak with families who are trying to navigate one of the hardest transitions in critical care: bringing a long-term ventilated, tracheostomy-dependent loved one home from ICU (Intensive Care Unit) or from hospital. This week, I spoke to Sarah, whose 102-year-old mother has been bouncing between ICU and a rehab facility for close to two years with a tracheostomy and ongoing ventilator dependence. Sarah’s question to me was simple, but it’s the question that sits underneath almost every call I take.

 

Sarah said, “My 102-year-old mother has been on a ventilator with a tracheostomy for almost two years, moving back and forth between ICU and rehab. She’s alert, she’s exercising, she wants to eat regular food again, and more than anything, she wants to live and she wants to go home. Is that realistic, and how do we make it happen safely?”

 

If you are asking any version of this question about your own parent, spouse, or child, this video and article today is for you. I’ll break down the clinical picture, explain why patients like Sarah’s mother end up bouncing between hospital and rehab, what treatment and weaning options are actually on the table, and most importantly, why the first step is never a moving truck or a hospital bed order — it’s actually the medical records.

 

The Clinical Picture:

 

Before going there, you might be wondering what makes me qualified to answer questions like this from Sarah. I have worked in critical care nursing for over 25 years in three different countries, where I worked as a nurse manager for over five years. I have been running Intensive Care at Home since 2012 here in Australia. We are the only third-party accredited Intensive Care at Home nursing service — ISO 9001:2015 accredited, as well as NDIS registered.

 

Here is what I was able to get together from my conversation with Sarah, and it’s a picture I constantly see in families calling me from all over Australia, the US, the UK, Canada, and beyond:

 

A 102-year-old woman with a tracheostomy in place for close to two years.  Ventilator dependent mainly overnight, with tracheostomy collar (also known as a T-piece) trials during the day as part of an ongoing weaning attempt.  Alert, oriented, engaging in active limb exercises and mobilization to a chair daily.  Wanting to return to a normal oral diet, having tolerated regular food in the past. A recent hospital readmission roughly three weeks ago for pneumonia.  Currently on telemetry in ICU, with a plan to transfer back to the rehab facility she has lived in on and off for close to two years.

 

On paper, this is actually a relatively encouraging clinical picture. Alertness, active mobilization, a family-supported home environment already wired for a ventilator, and demonstrated tolerance of oral intake in the past are all positive prognostic signs. The tracheostomy itself was placed for secretion management, a very common indication, rather than because of an unwearable respiratory drive, which is rather remarkable for a 102-year-old lady.

 

Why Does This Keep Happening — Bouncing Between ICU and Rehab?

 

One of the most important things I unpacked with Sarah was why her mother has been going back and forth between ICU and rehab for almost two years instead of progressing in a straight line toward either full weaning or a stable, supported discharge home. In my experience, this pattern almost always comes down to one or more of the following:

 

Recurrent respiratory infections — in this case, pneumonia — that interrupt the weaning process and trigger hospital and ICU readmissions.  A rehab facility that is simply not resourced or staffed at the critical care registered nurse level required to manage a tracheostomy ventilator safely, let alone progress weaning, meaning any deterioration sends a patient straight back to hospital rather than being managed on site.

 

Secretion management difficulties, which is exactly why this tracheostomy was placed in the first place, and which remain an ongoing risk factor for aspiration and infection.

Slow, cautious weaning trials — trach collar during the day, ventilation overnight — that take time to consolidate, especially in a 102-year-old patient.

 

This is the core problem with the hospital–rehab cycle. Most rehab facilities and skilled nursing settings are not staffed with critical care registered nurses. They’re excellent at physiotherapy, mobility, and general nursing care, but tracheostomy and ventilator management require ICU-level clinical judgment 24/7 from someone qualified to manage it. When that’s missing, every setback becomes a hospital admission instead of being managed in place.

 

Based on what Sarah described, treatment and weaning options going forward are, and what a realistic pathway generally looks like for a patient in this situation: Continued, gradually extended trach collar (also known as T-piece) trials during the day, building tolerance before attempting to reduce or eliminate overnight ventilation.

Aggressive secretion management, including cough assist, suctioning as required, humidification, and normal saline nebulizers to reduce the risk of another pneumonia-driven setback.  A structured dietitian- and speech pathology-guided return to oral intake, given she has tolerated regular food before.  Ongoing active mobilization and limb exercises to preserve strength and reduce deconditioning.

 

A home ventilation setup with 24/7 critical care registered nurses — not general registered nurses, not community nurses, definitely not disability support workers — so that the same clinical vigilance that exists in hospital continues at home.

 

You can also read our full evidence-based approach to intensive care at home on our Evidence-Based Mechanical Home Ventilation Guidelines page, which sets out exactly how tracheostomy ventilation weaning, secretion management, and safe home transition should be approached.

 

If you listen to how I handled the call with Sarah, you’ll notice I kept coming back to one request: send me a medical record summary. Not because I doubted anything she told me, but because I cannot responsibly advise the family on bringing a ventilated, tracheostomy-dependent loved one home without understanding, in the clinician’s own words, exactly what has happened over the last two years.

 

A one-page medical summary tells me things phone calls simply can’t: the exact weaning trial data, the organisms cultured in the pneumonia episode, the ventilation settings actually required overnight, any swallowing assessment results, and the clinical reasoning behind why she keeps bouncing between hospital and rehab.

 

This is not a formality — it is the single most important piece of advocacy a family can do for themselves. Request the medical records, read them, or have someone like myself and my team, who understand ICU medicine, read them with you before you commit to a care plan, a facility, or a home setup. Too many families sign up for a discharge plan, a rehab bed, or a home care package without ever seeing the actual clinical picture in writing. Don’t be one of them.

 

If you’re facing a similar situation with your own family member — tracheostomy, ventilation dependence, BiPAP (Bilevel Positive Airway Pressure), CPAP (Continuous Positive Airway Pressure), a loved one bouncing between hospital and rehab — I offer a direct one-on-one consulting call, also through intensivecarehotline.com, which is our sister site where we provide consulting and advocacy for families in intensive care.

 

But it’s also important that you know: for this kind of situation — tracheostomy, invasive or non-invasive ventilation, or the need to get a loved one out of ICU and the rehab cycle for good — Intensive Care at Home is the service I founded to solve this very problem properly, because we provide 24/7 nursing care from critical care registered nurses, similar to an ICU — not with support workers, not with general registered nurses, but with proper ICU nurses — for invasive ventilation with tracheostomy for adults and children, non-invasive ventilation (BiPAP, CPAP), and tracheostomy care without ventilation for adults and children.

 

We are the only Intensive Care at Home nursing service in Australia that is third-party accredited for intensive care at home nursing to ISO 9001:2015 standards, as well as NDIS registration. You can review our accreditation and quality credentials on our website, and I’ll put a link to that in the show notes.

 

I use a very simple analogy for why this matters: a support worker or a general registered nurse in your home is like the cabin crew flying the airplane instead of the pilot. For a patient on a ventilator with a tracheostomy, you need a pilot in the cockpit — a critical care registered nurse or an ICU nurse who has managed exactly this kind of complexity in an ICU. That’s the standard we hold ourselves to at every one of our clients’ homes, every shift, every day.

 

Bottom Line is this:

 

A 102-year-old, alert, mobilizing, tracheostomy- and ventilator-dependent patient who has been bouncing between hospital, ICU, and rehab for two years can absolutely go home safely — but only with the right clinical picture in hand and with the right level of 24-hour critical care nursing care in place. Get the medical records first, understand exactly what’s driving the hospital–rehab vicious cycle, then we build a home care plan around 24/7 critical care registered nursing — not a downgrade to support worker care that leaves your family and your loved one exposed.

 

I can help you at intensivecareathome.com. Call me on one of the numbers at the top of our website at intensivecareathome.com or book a call with me by clicking the schedule appointment button, or send me an email to https://intensivecareathome.com/services/

 

Also keep in mind: an ICU bed costs $5,000 to $10,000 per bed day, and we can provide intensive care at home for 50% of that cost, so any funding body has a strong interest in cutting the cost of an ICU bed by approximately 50%.

 

If you’re watching this and you’re in the US, the UK, Canada, India, or wherever you are, and you are interested in intensive care at home, please reach out to us as well — we can help you there privately.

 

With all of that said, with Intensive Care at Home, we are currently sending our critical care nurses into the home 24 hours a day. Therefore, we are providing a genuine alternative to long-term stay in intensive care for:

 

• Ventilation
• Tracheostomy
• Home BiPAP (Bilevel Positive Airway Pressure) and CPAP (Continuous Positive Airway Pressure)
• Tracheostomy care without ventilation
• home TPN (Total Parenteral Nutrition)
• Home IV potassium
• Home IV magnesium
• Home IV antibiotics
• Home IV fluids

 

We’re providing:

 

• Cough assist management at home
• Ventilation weaning management at home
• central line, PICC (Peripherally Inserted Central Catheter) line, Hickman’s line as well as port management at home
• nasogastric tube, nasojejunostomy tube, PEG (Percutaneous Endoscopic Gastrostomy), PEJ (Percutaneous Endoscopic Jejunostomy) tube management at home
• IDC (Indwelling Catheter) and SPC (Suprapubic Catheter) management at home
• Palliative care services at home

We’re also sending our critical care nurses into the home for emergency department bypass services. We have done so successfully as part of the Western Sydney Local Health District’s In Touch program, saving approximately $2,000 per patient that we keep at home instead of them going into an emergency department.

 

That also means we’re in a position to cut the cost of an ICU bed by around 50%. An intensive care bed costs between $5,000 to $10,000 per bed day depending on location. Intensive Care at Home costs approximately 50% of that, and we’re freeing up the most sought-after bed in the hospital, which is the ICU bed. Most importantly, we’re improving the quality of life for patients and their families, which is a win-win situation for all stakeholders.

 

Our Coverage and Accreditation

With Intensive Care at Home, we’re currently operating all around Australia, in all major capital cities, as well as in all regional and rural areas. We are an NDIS approved service provider all around Australia, TAC (Transport Accident Commission) and WorkSafe in Victoria as well as the Department of Veterans Affairs all around Australia.

 

We’re also ISO 9001:2015 accredited. Our clients and we as a service provider have also received funding through public hospitals, private health funds as well as departments of health.

We are the only service provider in Australia that has achieved third-party accreditation for Intensive Care at Home nursing in 2025. We have been achieving this high level of accreditation since 2012. No other provider in Australia has achieved the Intensive Care at Home level of accreditation in the community and has created more intellectual property when it comes to Intensive Care at Home nursing than we have.

This puts us in a position to employ hundreds of years of critical care nursing experience combined in the community. No other service provider in 2025 employs a higher skill level in the community than we do. And that enables us to look after the highest acuity adults and children in the community in Australia safely.

 

If You Need Help

 

If you’re at home already and you’re watching this or you’re stuck in an ICU and you realize that you don’t have the right level of support, I can give you many examples where we helped clients with funding, how we advocate for funding. We had to advocate successfully for funding from our first case study to many other case studies where we had to advocate successfully for funding with the right evidence of course because it is crystal clear that disability support workers for example or registered nurses without ICU experience cannot look after ventilated clients at home whether adults or children with or without a tracheostomy and it’s simply dangerous and negligent.

 

There are plenty of examples where clients with support worker models or even RN (registered nurse) models without ICU experience have died at home and I have evidence to back up everything that I’m saying here because it’s a bit like flying the airplane with a cabin crew instead of the pilot and it could simply be deadly.

 

This can be avoided by having simply 24-hour critical care nurses at home because our clients are at high risk of medical emergencies or worse without critical care nurses 24 hours. This is actually also evidence-based in the community and is documented in our evidence-based Mechanical Home Ventilation Guidelines on our website at intensivecareathome.com.

Think about it: in an intensive care unit in a hospital, you wouldn’t have support workers or general registered nurses looking after a critical care patient on a ventilator with a tracheostomy. So why would anyone in their right mind do that in a home care environment where there are fewer resources?

Clients that have found us have been at home long-term predictably and permanently with critical care nurses. Their alternative would have been to either die or stay in ICU long-term, and our clients don’t go back to ICU. They stay at home permanently and predictably and the insurance bodies save half of the cost of an ICU. But it’s a win-win situation all around.

We can do the same for you if you’re stuck in ICU or if you’re not safe at home, which includes the advocacy for funding and the network that goes along with it. We have always successfully advocated for our clients or we have the network to successfully advocate for you and for your family member, otherwise we wouldn’t be in business. The same again is applicable for those stuck in an ICU which is similar to many of our, if not most of our cases.

Our Support Coordination Services

 

This is also why we are providing Level 2 and Level 3 NDIS support coordination. We have a team of experienced NDIS support coordinators, and they have a wealth of knowledge. We’re also providing TAC case management and WorkSafe case management in Victoria with Lucy McCotter.

 

If you’re an NDIS support coordinator or a case manager or a social worker from another organization or a hospital watching this and you’re looking for nursing care for your participants, please reach out to us as well. If you’re looking for funding for nursing care for your participants and you don’t know how to go about it and how to advocate for it, what evidence to provide, I encourage you to reach out to us as well. We have the network to make that happen. We will help you with the right level of funding and with the right level of advocacy.

 

We’re also providing NDIS specialist nursing assessments done by critical care nurses with a legal nurse consulting background.

 

Join Our Team

 

If you are a critical care nurse and you’re looking for a career change and you want to join a very progressive, dynamic, successful, and high-performing team of critical care nurses in the community, we are employing hundreds of years of critical care nursing experience combined.

 

If you’re looking for a career change, we’re currently hiring for jobs for critical care nurses in Melbourne, Sydney, Brisbane, Albury-Wodonga, Bendigo, Geelong, Warragul, and also in Wyelangta in Victoria.

 

If you have worked in critical care nursing for a minimum of two years, adult ICU, pediatric ICU, ED and you have already completed a postgraduate critical care nursing qualification, we will be absolutely delighted hearing from you.

 

I have a disclaimer though: Because we are offering tailor-made solutions for our clients which includes regular staff, our clients do also want the same staff coming over and over again because they are so vulnerable and so special. That’s why we need regular, reliable staff.

 

If you’re looking for agency work where you can come and go, this will not be the right fit for you. We’re looking for consistency and our clients are looking for consistency. So please only apply with us if you can give us regular and consistent availabilities for shifts and you’re really keen on building relationships with us and with our clients. Reliability is also a must.

 

For Medical Professionals and Healthcare Executives

If you’re an intensive care specialist or an ED specialist, we also want to hear from you. We’re currently expanding our medical team as well.

 

We can also help you eliminate your bed blocks in your ICU and in your ED for your long-term patients or for your regularly readmitting patients with our critical care nursing team at home. We’re here to help to take the pressure off your ICU and ED beds. In most cases, you won’t even pay for it. Even if you do pay for it, it is so much more cost-effective than what you’re paying for in ICU and ED settings, and you get the same level of care and simply more patient and family satisfaction because you also want to partner with your consumers.

 

If you are a hospital executive watching this, we can help you free up your ICU and ED beds.

International Support

 

If you’re in the U.S. or in the UK and you’re watching this and you need help, we want to hear from you as well. We can help you there privately with one-on-one consulting and with hiring nurses privately.

 

Once again, our website is intensivecareathome.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected].

 

If you like my videos, click the like button, subscribe to my YouTube channel for regular updates for families with Intensive Care at Home and intensive care. Click the like button, click the notification bell, and share this video with anyone who has a family member in intensive care long-term or needs to see this.

 

Thank you so much for watching.

 

This is Patrik Hutzel from intensivecareathome.com and I’ll talk to you in a few days.

 

Take care for now.