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 on non-invasive ventilation such as BiPAP (Bilevel Positive Airway Pressure) and CPAP (Continuous Positive Airway Pressure), tailor-made solutions for tracheostomy clients at home without ventilation for adults and children, tailor-made solutions for home ventilation weaning, home cough assist management, home TPN (Total Parenteral Nutrition), home IV fluids, home IV antibiotics, home IV potassium, home IV magnesium, at home PICC (Peripherally Inserted Central Catheter) line, central line, Hickman’s line, port management at home, PEG (Percutaneous Endoscopic Gastrostomy)tube, nasogastric tube, nasojejunostomy tube, IDC (indwelling urinary catheter) and SPC (suprapubic catheter) management at home, as well as palliative care.

 

Today, I have a question from Liana, and before I go into today’s question, what makes me qualified to answer those questions? I’m a critical care nurse with over 25 years of critical care nursing experience in three countries, where I worked as a nurse manager for over 5 years. I was part of setting up Intensive Care at Home in Germany in the early 2000s, and I’ve been setting up Intensive Care at Home very successfully here in Australia since 2012. We have a very large team working for us here at Intensive Care at Home, so let’s get right into Liana’s question, who says:

 

“Hi Patrik,

My mom is in ICU. She started with a broken leg, which was initially fine, but I told the ICU doctor her kidneys were not the best and asked them to call her nephrologist. They didn’t. Finally they did, and he was horrified. It almost cost her life. They tried to do dialysis. They had to put in an endotracheal tube and dialysis CRRT (continuous renal replacement therapy).

 

A week later they said they could do no more. Over a month, many rounds of dialysis, they got the ET (endotracheal) tube out, and she has a tracheostomy. Half the time on the ventilator, she does her own breathing. I talked to the respiratory company and they said a home ventilator is no big deal, and they could teach me in a day since I was an EMT (emergency medical technician). She also has a stomach PEG tube. Nobody’s willing to help. The hospital said they have never discharged a person to go home for dialysis or a ventilator or a tracheostomy.

 

They’re pushing me hard to place her in a facility that costs $607 per day. So how and what could Intensive Care at Home help me with? “

 

Thank you so much from Liana.

 

Liana, thank you so much for reaching out and I can only imagine how exhausting and frightening this must be for you right now. You’re doing everything right by asking the right questions and pushing for your mom’s rights. Let me address every part of your situation in detail.

Number one, what has happened to Liana’s mom and why this ICU journey matters.

 

Let me summarize, Liana, what has actually happened here, because it is critically important for families in intensive care watching and reading to understand the chain of events. Liana’s mom was admitted with a broken leg, what seems to be a routine admission. The ICU team was informed her kidneys were not at their best, and Liana specifically asked the hospitalist to call the nephrologist, which they didn’t. By the time they did, the nephrologist was horrified, and that delay almost cost Liana’s mom her life. This is a textbook example of what I call preventable ICU deterioration, a medical error driven by poor communication and failure to follow the family’s clearly stated instructions and concerns.

 

As a devastating result, Liana’s mom required an endotracheal tube, CRRT, which stands for continuous renal replacement therapy, that is an intensive form of dialysis used in ICU, and over a month of treatment in ICU. She has now progressed to where she has a tracheostomy, is doing some of her own breathing, is on intermittent ventilation support, and also has a PEG tube for feeding. She is highly dependent on dialysis. She is medically complex, but she is alive. She is breathing on her own part of the time, and she has a dedicated daughter fighting for her.

 

The key point is the hospital dropped the ball by not calling the nephrologist when asked. Liana’s mom paid the price, and that is not Liana’s fault, and it should not be used as a reason to warehouse her mom in ICU. Liana deserves real options and more importantly, her mom deserves real options. If you are in a situation like that where you think the hospital or the ICU is not doing the right thing, I highly encourage you to check out our sister site at intensivecarehotline.com, where we provide consulting and advocacy for families in intensive care.

Now, number 2, Liana says that the ventilator company told her they can teach her in a day, and that will only kill your mom, Liana.

 

Let me address this very directly, Liana, because I genuinely care about your mom’s safety and about your well-being and about your peace of mind. You spoke to the respiratory company and they told you that managing a home ventilator is no big deal, and that they could teach you in a day because you were an EMT. I want to be absolutely clear: if you take on the role of primary carer and nurse for your ventilator and dialysis dependent mom based on a one-day training session, you will put her life at severe and immediate risk. I say this not to frighten you, but because I’ve worked in critical care nursing for over 25 years in 3 different countries. I have decades of experience in intensive care as well as with Intensive Care at Home, and I’ve seen over and over again what happens when untrained or undertrained personnel or family members manage these patients at home. People will die. Your mom will die. It’s not a matter of if, it’s a matter of when.

 

This is not about doubting you, Liana. You clearly love your mom deeply. You’re an EMT. You’re intelligent, you’re resourceful, and you have gone to extraordinary lengths to find solutions. But an EMT background, as valuable as it is, does not prepare you for 24/7 ongoing clinical complexity and intensive care nursing complexity of managing a tracheostomy, a ventilator, a PEG tube, and dialysis dependence in a home care environment without immediate backup.

 

And here is what the evidence actually says. We have published evidence-based Mechanical Home Ventilation Guidelines on our website, which you can read at intensivecareathome.com, because these evidence-based mechanical ventilation guidelines are based on over 25 years of Intensive Care at Home nursing experience from Germany and over 13 years of Intensive Care at Home nursing success in Australia. These guidelines are unambiguous. The nursing care of a ventilated adult or a child in the home can only be safely provided by a specialized and third-party accredited nursing service. Let me repeat that: the nursing care of a ventilated adult or child in the community or in home can only be safely provided by a specialized and third-party accredited Intensive Care at Home nursing service. That service must be capable of providing 24/7 specialized intensive care nursing care at home and must be contactable 24/7. Every nurse providing care must have a minimum of 2 years of clinical ICU or critical care nursing experience within the last 5 years. Every nurse must have completed a postgraduate degree or certificate in intensive care or critical care nursing.

 

That is exactly the requirements we are bringing to the table at intensivecareathome.com. We are third-party accredited. As a matter of fact, we are the only third-party accredited nursing service for Intensive Care at Home in 2026 in Australia. No other service has achieved this high level of independent third-party accreditation, and we are the only provider that has achieved that since 2012 on an ongoing basis.

 

For you, a respiratory company rep teaching you ventilator basics in a single day doesn’t come close to meeting these standards for Intensive Care at Home. The respiratory company’s job is to supply and service the equipment. Their job is not to make clinical judgements about whether you are safe to manage a tracheostomy semi-emergency at 3am when your mom is desaturating.

 

The reality check is that in ICU a ventilated patient with a tracheostomy has a 1 to 1 nurse to patient ratio with critical care registered nurses who have years of ICU training, who have an in-charge nurse on their shift. Those nurses have a full team behind them, other nurses, doctors, respiratory physicians, pharmacists, physiotherapists immediately available 24 hours a day. At home, if you’re the only person responsible for your mom, you have none of that backup. The margin for error is zero. Let me repeat that: the margin for error is zero. Tracheostomy emergencies, ventilator alarms, ventilator emergencies, sudden respiratory deterioration, PEG tube complications or dislodgements, tracheostomy dislodgements — these are life-threatening events that require immediate skilled clinical intervention. Being taught in a day does not prepare you for this. Doing the work yourself will kill your mom. The only people who can do the work safely are critical care registered nurses with a third-party accredited provider, which is Intensive Care at Home.

 

I understand, Liana, that this may sound harsh, but I would rather be upfront with you now than have you face an outcome that can never be undone.

So let’s look at number 3. What does your mom, Liana, actually need to come home safely?

 

The good news, Liana, is that your mom can potentially come home. Patients with tracheostomies, ventilators, PEG tubes, and dialysis dependence have come home before. It is very complex. It requires significant coordination, but it is not impossible. And you’re right that the hospital’s claim that they have never discharged a patient home for dialysis or a ventilator or a tracheostomy is not a reason it cannot happen. It just means they haven’t done the work, they haven’t done the research.

 

Here’s what your mom needs to come home safely, Liana. A specialized third-party accredited nursing service, and that accreditation needs to be for Intensive Care at Home, not a general nursing agency. The nursing agencies you have contacted and found to be unwilling or unable to help are general agencies. They’re not specialized, they’re not equipped, they’re not third-party accredited for Intensive Care at Home for this level of care. What your mom needs is a specialized Intensive Care at Home nursing service, third-party accredited, for exactly this type of care, where your mom can have 24-hour intensive care nurses at home. We at Intensive Care at Home are the only Intensive Care at Home nursing service in Australia that is third-party accredited for Intensive Care at Home nursing. We have all the intellectual property, we have the team for Intensive Care at Home nursing, and you can verify that at intensivecareathome.com/accreditation-quality. We have held this accreditation continuously since 2012. No other provider in Australia is third-party accredited for Intensive Care at Home. And this accreditation is not a marketing badge. It means that we have policies, procedures, a clinical governance framework, and the intellectual property to safely provide Intensive Care at Home nursing at the standard the evidence requires. Our accreditation is ISO 9001:2015 and the NDIS (National Disability Insurance Scheme) Quality and Safety Commission certified standards. We have been audited by BSI Group with zero non-conformances in our recent audit.

 

Critical care registered nurses 24 hours a day. Your mom’s care at home needs to be delivered similar to an ICU, with 24-hour critical care registered nurses, not general registered nurses, definitely not support workers, not an EMT family member doing their best. ICU nurses 24 hours a day, similar to an intensive care unit in a hospital, around the clock. That is what the evidence-based Mechanical Home Ventilation Guidelines require, and that is what we provide.

Let’s now look at coordinating with a dialysis service.

 

Your mom requires ongoing dialysis, and that is an additional layer of complexity that needs to be carefully planned and addressed. Hemodialysis or peritoneal dialysis in the home setting requires its own specialist coordination. The dialysis provider, the treating renal physician, and the home nursing team all need to work together with a single coordinated plan. You mentioned exploring peritoneal dialysis, and that is certainly worth a serious conversation with the renal team. Peritoneal dialysis can in some cases be more suitable for home management than hemodialysis, but that clinical decision needs to come from your mom’s nephrologist and renal team, not from the nursing service.

 

Let’s now look at PEG tube and nutrition management.

 

Your mom has a PEG tube for feeding. This is within the scope of our nursing care. We routinely manage ventilation, tracheostomy, PEG tubes, feeding pump management, and associated care at home. This is not an obstacle to discharge, if anything, it lines up with our area of expertise, our specialty, and our accreditation.

 

Now let’s look at equipment. You have done remarkable homework on the equipment side, ventilator, dialysis supplies, low-loss mattress, oxygen concentrator, feeding pump, power wheelchair. You have identified that Medicare and other insurances will cover these, and that is an important foundation. But equipment without the right 24/7 Intensive Care at Home nursing team is just machinery.

 

Now let’s look at the $607 per day facility versus getting your mom home.

The hospital is pushing you towards a nursing home facility that costs $607 a day. Just keep in mind that an ICU bed costs $5,000 to $10,000 per bed day. With Intensive Care at Home, the funding body pays about half of that. $607 a day for a nursing home facility is a death sentence, because they have no skills or expertise to look after your mom. Like I said, it’s a death sentence and nothing else. Those figures need to be questioned — what level of nursing care do these facilities actually provide? You won’t get any nursing care for $607 a day, not for an ICU patient. Like I said, it will unfortunately only be a death sentence. They’re not equipped for ventilator-dependent, dialysis, tracheostomy patients with PEG tubes. They will struggle the moment your mom is being pushed through the door.

The financial case for Intensive Care at Home is real and well documented. Our clients have found that bringing a loved one home with 24-hour critical care nursing is very cost competitive or much cheaper than long-term ICU stays. It’s been a win-win situation from day one, and the funding is there because funding bodies recognize that we cut the cost of an ICU bed by roughly 50%, and the quality of life outcomes are incomparable. Home is home.

 

Funding options worth exploring for your mom, Liana: private health insurance – your mom has a long-term private health policy, and this is worth a very detailed conversation with the insurer about what home nursing cover is included, especially keep in mind that your mom’s health insurance is paying $5,000 to $10,000 per bed day right now. Then Medicare coverage of equipment, which you have already identified. State and federal homecare packages depending on your mom’s age, citizenship, and disability status such as Departments of Health, hospital funding directly because they are paying for the ICU bed. Departments of Health, NDIS if you’re in Australia, DVA (Department of Veterans’ Affairs) — there are definitely options for your mom, hands down. And if your mom is under 65, NDIS funding is relevant. We are a registered NDIS provider with NDIS provider number 4050000298. We operate all around Australia, in all major capital cities, in all regional and remote areas, in all states and territories.

 

Let’s look at number 5 now — the hospital won’t listen. What can you do, Liana?

You mentioned something that I hear from families constantly. The hospital pushes back hard when you ask for something different. They’re used to the flow of patients going to facilities. They have never discharged a patient home on a ventilator or dialysis, and so they default to telling you it can’t be done. It can be done, and you have rights. You have the right to request a formal discharge planning meeting that includes the ICU team, the respiratory team, the renal team, a social worker, and external providers. You have the right to bring an advocate to that meeting. You have the right to reject a placement you do not believe is appropriate for your mom. You have the right to seek a second opinion. You have the right to ask for Intensive Care at Home. The hospital’s discomfort with your request does not override your or your mom’s rights. The team not being familiar with home ventilation or home dialysis is their limitation, not yours. And it is absolutely not a reason to place your mom in a facility she doesn’t need to be in, if home with Intensive Care at Home is a safe and viable option.

And here’s an advocacy tip. If you’re experiencing pushback, pressure, or what feels like coercion from hospital management or the ICU team, the fear you describe of going to your mom’s room in case you or she gets verbally abused, that is a serious patient rights and advocacy issue. This is exactly the kind of situation where professional ICU consulting and advocacy support will make all the difference, and that’s what we do at our sister site at intensivecarehotline.com.

 

So, how can we here at intensivecareathome.com help you right now, Liana?

This is the most important question of all. Specifically, how we help with Intensive Care at Home in similar situations or in your situation, Liana. We consult with you one on one, understand exactly where your mom is clinically, and what the realistic pathway home looks like. We have done it so many times, we can identify that for you very quickly — how we can get your mom home safely, predictably, with the right funding. We help you understand your rights in relation to the hospital’s discharge planning process, identify the funding levers available to you, prepare you to have a very different and more effective conversation with the ICU team, and we show you the pathway for Intensive Care at Home with viable options for your mom’s specific situation.

 

The next step would be a clinical assessment for Intensive Care at Home nursing. Once we understand your mom’s situation in detail, our clinical team will assess whether an Intensive Care at Home nursing package is appropriate, to what extent, and we would look at her ventilator requirements, tracheostomy type and status, dialysis needs, PEG tube management, and the home environment. We operate all around Australia, in all major capital cities, in all regional and remote areas, as well as in all states and territories. We have over 150 critical care registered nurses on our team. We have been doing this very safely since 2012. We are the only third-party accredited provider in Australia for Intensive Care at Home, and we deliver evidence-based nursing care.

The next step is discharge coordination and planning with you. We work with ICU teams, respiratory doctors, renal teams, and families to develop a coordinated plan for safe discharge home. We deal with resistant hospitals regularly. We know how to have these conversations and make it a win-win situation for everyone, and we know how to get patients home who the hospital assumed would never leave alive.

 

A note about your mom’s safety in that hospital, Liana. You mentioned that you fear going to your mom’s room in case you get yelled at, or worse, that management might verbally or physically take it out on you, on your daughter, or on your mom. I want to take that very seriously. If you genuinely believe your mom is being mistreated, bullied, or that your advocacy for her is leading to her being treated differently by staff, that is a patient safety and patient rights issue. You can raise a formal complaint with the hospital’s patient liaison or patient rights office. You can contact the relevant state health complaints body. And if there’s any risk of physical harm, that is a matter for law enforcement. You are your mom’s best advocate. Do not let anyone make you feel that advocating for your mom is wrong. If anything, it’s the right thing to do, and it’s the most important thing you can do.

 

In summary, Liana, your mom’s situation, tracheostomy, partial ventilator dependence, dialysis, PEG tube is complex, but not impossible to manage at home with the right level of support. More importantly, with the right mindset and with the right team. And by the way, we help you select the right team, we hire ICU nurses that you can know, like, and trust in your own home. We help you with that, and we get you involved in the hiring process if you want that. Being taught in a day by a respiratory company rep and doing the work yourself is not safe. If anything, it would be a death sentence for your mom, because it puts your mom’s life at risk. You need a specialized, third-party accredited 24/7 critical care nursing team. Intensive Care at Home is the only third-party accredited Intensive Care at Home nursing service in Australia in 2026. We have been doing this since 2012. Our evidence-based mechanical ventilation guidelines clearly define the standard of care required. It is not a one-day training for a family member. And the hospital pushing you towards a residential aged care facility is not an option. It is also a death sentence. Home is safe with Intensive Care at Home, it is viable, and much more cost-effective than an intensive care bed. We provide the right teams, the right mindset, and the right infrastructure.

 

Start with calling us today at intensivecareathome.com or send us an email to [email protected]. And if you’re watching this from the U.S., from the UK, from Canada, or any other English-speaking country, we can help you there privately. Please reach out to us as well at intensivecareathome.com.

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.