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“The nephrologist is not allowing my daughter to come home from ICU with Intensive Care at Home due to her having a tracheostomy, brain injury , and needing dialysis. The nephrologist says, because she’s nonverbal, she’s not allowed to come home.” This is an email from Vanessa, and I’ll answer that today.

My name is Patrik Hutzel from intensivecareathome.com, and let’s look at this closer.

So, I know that Vanessa has been devastated by getting those news from a nephrologist, but it’s not what people do or what they say, it’s about how you react that makes all the difference because you can’t control other people, but how you react is 100% within your control. So, let’s not have the opinion of someone become your reality, that’s also very important. Let’s not have other opinions about the subject become your reality, that’s what we’re trying to achieve here today.

Let’s break this down. If the nephrologist is not allowing your daughter to come home with Intensive Care at Home from ICU due to her having a tracheostomy, brain injury and needing dialysis, and because the nephrologist is saying she’s nonverbal, she’s not allowed to come home, what a whole lot of rubbish because it is not up to the nephrologist to determine what can be happening at home.

So I’m very sorry that you are facing this, Vanessa. But what the nephrologist is saying is probably not accurate, or even legally supportable, depending on your location, of course, and the specific medical circumstances. But I can tell you, we’ve been running Intensive Care at Home now since 2012, and prior to that, I’ve worked in the same space in another country, in Germany. I can tell you we have looked after many clients at home with a tracheostomy needing dialysis.

But let’s break this down further. Home care with dialysis is absolutely possible, including for patients or clients with tracheostomies and brain injuries, and even on dialysis. Can they receive home care 24 hours with the right level of support? Of course, and that’s what we do here at Intensive Care at Home. Because with our critical care nurses, that you get 24 hours a day and dialysis technicians.

Not being nonverbal does not disqualify someone from receiving home care. Many, if not most of our clients are nonverbal or have difficulties communicating, that does not exclude them from going home. If anything, that will foster them going home because in a hospital environment, nurses, doctors come and go, it’s highly transient. Whereas in the home care environment, we are trying to always create stable teams for our clients so that communication with clients is getting easier over time, not more difficult.

Having a stable team who gets to know our clients, gets to know their preferences, gets to know what they don’t like, that’s the whole concept of home care. That’s the whole philosophy of home care- to make patient care more client centric because that’s not what they’re not getting in a hospital. If a nephrologist is trying to override the wishes of your daughter, and I know the wishes of yourself, that is highly inappropriate.

So, with home dialysis, that can be done by a peritoneal dialysis or it can be done as an outpatient in a dialysis center because your daughter will need 24 hour critical care nurses anyway because of the tracheostomy. We can take your daughter to a dialysis center. Nothing’s stopping us. So like I said, do not let other people’s opinion about something become your reality. You don’t need to buy into it, you just need to ask for the right questions.

Next, there are disability rights and also medical discrimination. Refusing discharge home because your daughter is nonverbal is a violation of her rights under the Disability Act. The Disability Act prohibits discrimination based on disability in medical and disability services and also accommodations.

Next, get a second opinion from another nephrologist or from a critical care physician, palliative care physician, hospital physician and others. Once again, do not let other people’s opinion about something become your reality.

Next, demand a formal discharge planning meeting with hospital care team, social worker, case manager, and Intensive Care at Home so that we can take the next steps here. Ask them to put their refusal or denial in writing, including the specific reasons she “can’t get home.” This forces more careful justifications and can reveal a lack of real bias or it can reveal the bias.

Also, involve patient advocates or legal support if you feel like your daughter’s rights are being violated. Ask the hospital to connect you with the patient advocate or ombudsman. We also provide advocacy, of course, for our clients, contact disability rights organizations or medical advocates in your area. If necessary, talk to lawyers as well specializing in medical advocacy or disability law.

But, I think what I can see with what you’ve shared with me, and we’ve looked at the medical records as well here, Vanessa, there’s nothing stopping your daughter from going home once the right support structure is in place. So, definitely don’t despair here, there is a solution. We are looking after much more complex clients at home than your daughter, and the dialysis and the tracheostomy will not stop her from going home, assuming we can get the funding, and she’s medically stable. But it sounds like she’s medically stable, there’s nothing stopping her from going home.

So, with Intensive Care at Home, we are currently sending our ICU and critical care nurses into the home, 24 hours a day. We are providing the following:

• Home care services for ventilated adults & children with tracheostomies
• Genuine alternative to a long-term stay in intensive care/ long-term acute care
• Tracheostomy care
• Home care services for patients on non-invasive ventilation – Home BIPAP (Bilevel Positive Airway Pressure), Home CPAP (Continuous Positive Airway Pressure
• Home TPN (Total Parenteral Nutrition
• Home IV potassium and home IV magnesium infusions, IV fluids, and IV antibiotics
• Provides central line management, PICC (Peripherally Inserted Central Catheter) line management, Hickman’s line management, as well as port management at home.
• Provides nasogastric tube  and PEG (Percutaneous Endoscopic Gastrostomy tube management at home
• Palliative care services at home
• Use cough assist machines for our clients for airway clearance

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 Area Health District, their in-touch program, saving approximately $2,000 per patient that we keep at home, instead of them going to an emergency department .

That also means, we’re also in a position to cut the cost of an intensive care bed by around 50%. An intensive care bed costs between $5,000 to $6,000 per bed day. Our services costs between $2,500 to $3,000 per bed day 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. Of course, quality of life is much improved surrounded by families instead of staying in an intensive care unit.

With Intensive Care at Home, we are currently operating all around Australia in all major capital cities as well as in all regional and rural areas. We’re an NDIS (National Disability Insurance Scheme) approved service provider all around Australia, TAC (Transport Accident Commission) and WorkSafe in Victoria, iCare in New South Wales, NIISQ (National Injury Insurance Scheme in Queensland), as well as the Department of Veteran Affairs (DVA) all around Australia. 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 currently 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 level of accreditation since 2012. No other provider in Australia has achieved this high 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 which enables us to look after the highest acuity adults and children in the community in Australia safely.

If you’re at home already and you’re watching this, or you’re stuck in an ICU, like in our case study today or if you’re going to the hospital and ED all the time and you realize that you don’t have the right level of support, I’ll give you another tangible and real-world example today, very similar to what I gave you a minute ago. One of our first clients when we first got started over 10 years ago in 2012, was a client who was at home initially on a ventilator with a tracheostomy with a support worker model 24/7. Of course, support workers are not equipped to look after a ventilated and tracheostomy client. That is dangerous and it’s negligent. Having support workers looking after a client at home on a ventilator with a tracheostomy is like flying the airplane with the cabin crew instead of the pilot because anyone on a ventilator with a tracheostomy is at very high risk of medical emergencies 24/7 or even at risk of dying if they don’t have a team of critical care nurses looking after them 24/7 at home. This is actually evidence-based and is documented in our Mechanical Home Ventilation Guidelines, that you can find on our website at intensivecareathome.com.

Think about it, in an intensive care unit in a hospital, you wouldn’t have support workers looking after your critically ill loved one or after any critically ill patient on a ventilator with a tracheostomy. So, why would anyone in their right mind would do that in a home care environment in the community?

So, this client found out about us eventually and the ICU that he went back to all the time also knew about us and eventually reached out to us. We were proving our concept with this client very fast. When we worked with the ventilated and tracheostomy client, we sent him intensive care nurses, 24 hours a day. He never ever went back into ICU ever again as long as we worked with the client. We were proving our concept there very fast.

We can do the same for you if you’re not safe at home which includes the advocacy for funding that goes along with it. We have always successfully advocated for our clients. Otherwise, we would not be in business. The same is applicable for those stuck in an ICU, similar to our case study today or if you’re going back to ED all the time, reach out to us. We’ll make it happen for you as well. We can take you through the right steps including NDIS or other funding bodies and the advocacy that needs to go along with it.

This is also why we are providing  Level 2 and Level 3 NDIS Support Coordination. We have a team of NDIS Support Coordinators, and they have a wealth of knowledge. I’ve done an interview with Amanda Riches, one of our NDIS Support Coordinators, and I’ll put a link to an interview with Amanda in the written version of this blog. We’re also providing TAC case management and WorkSafe case management in Victoria.

If you’re an NDIS Support Coordinator or a case manager from another organization 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 what evidence to provide, I encourage you to reach out to us as well. 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.

If you are a critical care nurse and you’re looking for a career change, and you want to join a very progressive, dynamic, 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 are looking for a career change, we’re currently hiring for jobs for critical care nurses in Melbourne, Sydney, Brisbane, in Albury, Wodonga, in Bendigo, in Geelong, and in Warragul in Victoria. If you have worked in critical care nursing for a minimum of 2 years pediatric ICU, ED, and you have already completed a postgraduate critical care nursing qualification, we will be delighted hearing from you.

I do have a disclaimer though, because we are offering a tailor-made solution for our clients, which includes regular staff, our clients also do want the same staff coming over and over again because they are so vulnerable and so special, and that’s why we need regular staff. So, if you’re looking for agency work where you can come and go, this will not be the right fit for you. We are 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.

If you are 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 you 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, and you get the same level of care.

If you’re a hospital executive watching this and you have bed blocks in your ICU, ED, and respiratory wards, or home TPN, please reach out to us as well. We can help you eliminate your bed blocks very fast.

If you’re in the U.S. or in the U.K. 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, 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, share this video with your friends and families, and comment below what you want to see next and you think about this video and what you want to see next.

Thank you so much for watching.

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

Take care for now.