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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 tracheostomy, where we also provide tailor-made solutions for long-term ventilated adults and children at home on BiPAP (Bilevel Positive Airway Pressure) / CPAP (Continuous Positive Airway Pressure), also known as non-invasive ventilation (NIV); home tracheostomy care for adults and children without ventilation; home cough assist management; home ventilation weaning; home TPN (Total Parenteral Nutrition), home IV (Intravenous) fluids; home IV potassium; home IV antibiotics; home IV magnesium infusions; central line, PICC (Peripherally Inserted Central Catheter) line, Hickman’s line, port management at home; nasogastric tube, nasojejunostomy (NJ) tube, PEG (Percutaneous Endoscopic Gastrostomy), PEJ (Percutaneous Endoscopic Jejunostomy) tube, SPC (Suprapubic Catheter), IDC (Indwelling Catheter) management at home, as well as palliative care management at home.

 

Today, I have a question from Robin who says:

 

Hi Patrik, 

 

My sister had open heart surgery over clogged stents. She was put on life support, 55 days in ICU (Intensive Care Unit). She had a tracheostomy put in and is no longer on the ventilator. She was transferred to a respiratory ward with a chance of coming off the tracheostomy, but now they are saying she cannot have the tracheostomy removed. Can we take my sister home with Intensive Care at Home?

 

From Robin.

 

Robin, thank you so much for reaching out. I know how overwhelming, emotionally exhausting, and draining this situation must feel. 55 days in ICU, open heart surgery, a tracheostomy, and now the hospital is telling you she cannot have it removed. That is an enormous amount to carry.

 

The good news, and the short answer, is yes — in all cases, your sister can absolutely come home with a tracheostomy, and we here at Intensive Care at Home are specifically built to make this happen safely, professionally, and with the same level of clinical care she would receive in ICU or on a respiratory ward. Let me walk you through exactly what that means, what a tracheostomy at home involves, and how our service works, so you and your family can make informed decisions.

 

WHAT IS A TRACHEOSTOMY AND WHY IS IT STILL IN PLACE?

A tracheostomy is a surgical opening made in front of the neck to provide a direct airway into the trachea (windpipe). It is used in the ICU when patients need prolonged breathing support, when they cannot protect their own airway, or when they are being weaned off a ventilator and that process takes time.

 

In your sister’s case, she has already come off the ventilator, which is a huge achievement after 55 days in intensive care. But the hospital is saying the tracheostomy cannot be removed. This is actually more common than most families realize, but it does not mean your sister is stuck in a hospital, in ICU, or on a respiratory ward forever.

 

There are several clinical reasons why a tracheostomy might not be removed, even when a patient is no longer ventilated:

 

•          The upper airway has become narrowed or damaged from prolonged intubation

•          There are ongoing secretion management issues

•          The patient needs regular suctioning that they cannot do independently

•          Swallowing function has not fully recovered, increasing the risk of aspiration

•          The vocal cords or subglottis have been affected

•          The medical team is still monitoring airway function before making a final decision

 

None of these reasons automatically means your sister has to remain in hospital or in ICU. They mean she needs specialized intensive care nursing at home. That is exactly what we do at Intensive Care at Home.

 

So, what the hospital is really telling you, when a hospital says she cannot have the tracheostomy removed, what they often mean is: we cannot safely remove it right now, and we are not confident about discharging her to a standard home environment without the right support. What they may not be telling you, and this is absolutely critical, is that with the right nursing team in place at home, discharge is very much possible with Intensive Care at Home.

 

Hospitals, ICUs, and respiratory wards are under enormous bed pressure. Respiratory wards are very busy.  The system is stretched, and often the discharge planning team simply does not know that a service like Intensive Care at Home exists, that it is even accredited, like we are. And also, they don’t know that it is evidence-based and fully equipped to manage patients with a permanent or semi-permanent tracheostomy at home.

 

Key insight for families here is: a tracheostomy does not mean your loved one must remain in hospital. With the right level of intensive care nursing at home, specialist nursing support at home, discharge is possible and in many cases, going home leads to significantly better outcomes for quality of life, recovery, and overall well-being for patients and their families

 

So, coming back to your original question, Robin, can your sister come home with a tracheostomy?   Yes, what we need to know every patient is different, and we would do a thorough clinical assessment before confirming that Intensive Care at Home is the right fit. But in general, patients with a tracheostomy in situ, whether they are ventilated or not, can be successfully transitioned home when the following conditions are met:

 

1.         Medically stable — the patient is not in an active crisis and has consistent, manageable care needs that can be managed at home with intensive care nurses.

2.         Airway management plan is in place — our intensive care nurses at home are fully trained in tracheostomy care, including suctioning, inner cannula changes, and emergency airway management.

3.         Appropriate home care environment — we work with families to ensure the home is set up correctly with the right equipment and the right levels of staff.

4.         Clear handover from the treating team — we liaise directly with hospital ICU, respiratory ward, and discharge planning teams.

5.         Nursing hours matched to clinical needs — so, with a tracheostomy, your sister will need 24-hour intensive care nursing, and that is actually evidence-based. You can look that on our evidence-based Mechanical Home Ventilation Guidelines that you can find at our website at intensivecareathome.com.

 

Again, in your sister’s situation, post open heart surgery, post ventilation weaning, now on a respiratory ward with the tracheostomy in situ, she sounds like exactly like the type of patient we support at home every single day with 24-hour intensive care nursing, so that patients can live a good quality of life at home instead of in ICU or on a respiratory ward, or in a hospital in general.

 

WHAT DOES TRACHEOSTOMY CARE AT HOME ACTUALLY LOOK LIKE?

I want to be very clear about what our nurses at home and we do because families often assume that tracheostomy care at home is somehow inferior to hospital care. It is absolutely not. Because we exclusively work with Critical Care Registered Nurses (CCRNs) with a minimum of 2 years critical care nursing experience in ICU because they are highly trained specialist. Here is what tracheostomy care at home with our service includes:

 

•          Regular and as-needed tracheostomy suctioning to keep the airway clear and patent

•          Inner cannula cleaning and replacement

•          Tracheostomy site dressing and skincare

•          Tracheostomy tape changes and skincare

•          Monitoring for any signs of infection, granuloma formation, or airway complications

•          Humidification management — which is critical for preventing secretion buildup, therefore preventing pneumonia, or chest infection

•          Nebulizer management – also critical for preventing secretions build up and pneumonia prevention

•          Speaking valve/Passy Muir Valve (PMV) support where appropriate to help with voice and swallowing rehabilitation

•          Liaison with speech pathology and respiratory teams for ongoing weaning and decannulation planning

•          Emergency airway protocols – our nurses are trained to respond to airway emergencies in the home

•          Family education when wanted, so your family is also confident and informed, the setup of any emergency equipment that is needed for a tracheostomy

 

This is not basic nursing by any stretch of the imagination. This is specialist critical care nursing in the home, delivered in the home on the same evidence-based standard we hold ourselves to in hospital and in ICU.

 

EVIDENCE-BASED GUIDELINES

Intensive Care at Home follows strict, evidence-based clinical guidelines for all patients, including those with tracheostomies. These are based on peer-reviewed literature, national and international best practice, and over 25 years of operational experience, starting in Germany and, since 2012, in Australia. These guidelines include:

 

•          Patient selection criteria and clinical assessment frameworks

•          Safe transition protocols from ICU and hospital to home

•          Tracheostomy and ventilator management in the home setting

•          Emergency response protocols

•          Staff competency and training requirements

 

When you bring your loved one home with Intensive Care at Home, you are not taking a chance, you are choosing a service that operates to the same standards as an ICU, and in many ways even higher standards than what your sister is currently receiving in a busy hospital.

 

WHY THIRD-PARTY ACCREDITATION MATTERS for you and your family

Intensive Care at Home is the only third-party accredited specialist home nursing provider in Australia in 2026. We are the only service provider in Australia that is third-party and NDIS (National Disability Insurance Scheme) registered for ventilator-dependent and medically complex patients, including tracheostomy. We hold ISO 9001:2015 certification and are certified by the NDIS Quality and Safety Commission standards, with zero non-conformances at our most recent audits.  This means when you choose our service, you are choosing a provider held to the highest possible independent standards, not just our word, but independently third-party verified by accreditation bodies. You can review our full accreditation and quality documentation at intensivecareathome.com/accreditation-quality.

 

We have built the intellectual property for Intensive Care at Home, policies, procedures, and more importantly, a team that can deliver that service. We employ hundreds of years of intensive care nursing experience combined in the community. No other provider has a highly skilled team equal to ours at Intensive Care at Home.

 

GOING HOME IS NOT GIVING UP — IT IS MOVING FORWARD

One of the biggest myths I hear from families is that going home means giving up on hospital treatment, or that the hospital has given up on their family member. Robin, nothing could be further from the truth. Choosing to bring your sister home with Intensive Care at Home is choosing a better quality of life — in a familiar, loving, warm environment with the same clinical expertise, and often with better outcomes because you simply in your own home.

The research is clear on this. Patients who are medically stable and receive appropriate nursing support at home consistently show:

 

•          Improved psychological well-being and reduced anxiety compared to prolonged hospital and ICU stays

•          Faster rehabilitation and recovery milestones when in a home environment

•          Fewer hospital-acquired infections and complications

•          Higher patient and family satisfaction

•          Significant cost savings compared to ongoing inpatient care

 

After 55 days in ICU, your sister deserves to be home. She deserves her family around her, and she deserves care that does not just stop because she has left the hospital wards.

 

With Intensive Care at Home, we currently operate all around Australia and we have a team of approximately over a hundred and fifty of critical care registered nurses, and we have grown.  If your sister is anywhere in Australia, we can assess whether we are able to support her, but even you are in the United States, the United Kingdom, or Canada, please reach out to us. We can help you there privately.

 

What to do next, Robin, go to intensivecareathome.com and call us on one of the numbers at the top of our website. Tell us more about your sister’s situation, and we will guide you through how we can help.  Your sister has already shown so much resilience, 55 days in ICU, open heart surgery, ventilation weaning, and now she is breathing on her own. That is extraordinary. The fact that her tracheostomy is still in situ does not mean her journey home is over. It means she needs the right team around her to make that journey safely.

 

Intensive Care at Home exists for exactly this reason. We are not a stopgap. We are not a compromise. We are a specialist critical care nursing service provider, delivering it in the place your sister deserves to be the most — her home.

Go to intensivecareathome.com, call us on one of the numbers on the top of our website, or simply send us an email to [email protected].

 

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 availability 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 channelor 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 reading.

 

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

 

Take care for now.