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My name is Patrik Hutzel from intensivecareathome.com,My name is Patrik Hutzel from intensivecareathome.com. Here at intensivecareathome.com, we provide tailor-made solutions for long-term ventilated adults and children with tracheostomies. We provide tailor-made solutions for long-term ventilated adults and children on non-invasive ventilation such as BiPAP (Bilevel Positive Airway Pressure), CPAP (Continuous Positive Airway Pressure), APAP (Auto-Adjustable Positive Airway Pressure), VPAP (Variable Positive Airway Pressure), tailor-made solutions for tracheostomy adults and children without ventilation, home ventilation weaning, home tracheostomy weaning, home cough assist management, home TPN (Total Parenteral Nutrition), home intravenous (IV) fluids, home IV antibiotics, home IV potassium, home IV magnesium infusions, central line, PICC (Peripherally Inserted Central Catheter) line, Hickman’s line, port management at home, PEG (Percutaneous Endoscopic Gastrostomy) tube, PEJ (Percutaneous Endoscopic Jejunostomy) tube, nasogastric tube, nasojejunostomy tube management at home, indwelling urinary catheter (IDC), suprapubic catheter (SPC) management at home, as well as palliative care management at home.

 

I am a registered nurse, having worked in critical care nursing for over 25 years in three different countries, where I have worked as a nurse manager for over five years in intensive care. I have been working with Intensive Care at Home services in Germany in the early 2000s and I have been setting up Intensive Care at Home successfully here in Australia since 2012.

 

Every week I receive questions from families across Australia and even from other countries around the world who are watching their loved ones languish in intensive care units (ICUs), in long-term facilities, stuck on ventilators, unable to get home. This week I want to walk through a real case — a man I will call Thomas — who is exactly the kind of patient we support at Intensive Care at Home and who, based on his medical records which we have access to, is a very strong candidate for going home with 24/7 critical care registered nurses rather than staying indefinitely in the ICU or in another institution that would not even be qualified to look after him.

 

Thomas is in his 60s. He has a complex neurological condition called Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) in a rare variant called multifocal acquired demyelinating sensory and motor neuropathy (MADSAM). Because of this, his respiratory muscles have been progressively weakening since early 2025. He now has a tracheostomy and has been ventilator-dependent since November 2025. He spent 45 days in a hospital ICU and has now been in a step-down ICU for over 69 days which means basically over 110 days in ICU or step-down ICU.

 

Here is what I want families and clinicians in this situation to understand. In many cases like this, going home with 24-hour critical care registered nurses is not only possible, it is safer, it is much more evidence-based than staying in an ICU or in a step-down ICU, and it is far more cost-effective than indefinite institutionalization, not even mentioning the quality of life improvements for patients and for families.

Let’s look at Thomas’s clinical picture and what it looks like.

 

Me and my team have reviewed Thomas’s medical records, pulmonary progress notes, respiratory progress notes, physical therapy and occupational therapy (OT) notes, ICU doctors’ and nurses’ reports. We’ve looked really at everything that was available to us. Here is what the records tell us.

 

The key clinical facts for Thomas are:

• Primary diagnosis: CIDP MADSAM with neuromuscular respiratory failure
• Tracheostomy placed in November 2025, currently using a Shiley cuffed tracheostomy
• On invasive mechanical ventilation at night
• Tracheostomy collar meaning spontaneously breathing during the day for up to 3.5 hours per session
• A blood gas from 23 February this year, while on the tracheostomy collar, shows a pH of 7.36 and a partial pressure of carbon dioxide (PCO2) of 60 mmHg which is way too high, and is probably why he cannot be weaned off the ventilator just yet. Normal PCO2 levels are between 35 and 45 mmHg, so a PCO2 of 60 is way too high. It means he is retaining carbon dioxide (CO2), which puts him back on the ventilator to get that CO2 down.
• PEG tube in place for nocturnal tube feeds; eating a regular diet with easy-to-chew textures and thin liquids orally during the day
• Dysautonomia managed with midodrine and droxidopa
• Hemodynamically stable
• Receiving monthly IV immunoglobulin (IVIG) for CIDP and that can be delivered at home

 

The OT notes say: eating is now at setup and clean-up level of assistance, grooming at setup level, upper body dressing at minimal assistance.

 

The physical therapy notes say: standing with a rolling walker, doing standing marches and therapeutic exercises, cognitively intact, alert, communicating with a Passy Muir speaking valve, able to direct his own care, weight improved from 53 kg to 61.2 kg. No active infection, afebrile, stable bloods.

 

What this picture really tells me is that Thomas is not a patient who needs an ICU. He needs skilled, specialized ICU nursing support to manage his airway, his ventilator at night, his tracheostomy, his dysautonomia, his PEG feeds, his ongoing rehabilitation, and his midodrine all of which can be delivered at home by critical care registered nurses.

 

Why a Ventilator-Dependent CIDP Patient Can Go Home

The reason most ventilator-dependent patients like Thomas end up in an ICU, a step-down ICU, or in the U.S. in long-term acute care (LTAC) facilities or skilled nursing facilities instead of going home, is not clinical. It is a failure of discharge planning, a lack of awareness that home ventilation nursing exists, and in some countries a funding gap, and in other countries also a service gap. Because if there is no Intensive Care at Home, there is no going home for these types of patients. But where families are informed and motivated, and where the right nursing services are involved, home is almost always achievable and of course the best course of action.

 

Also, CIDP is not a terminal diagnosis in the way amyotrophic lateral sclerosis (ALS) or motor neurone disease (MND) is. Thomas’s CIDP was treated aggressively in the ICU with IVIG and rituximab. His nerve biopsy confirmed demyelinating neuropathy, a condition that can improve with immunotherapy such as IVIG. His respiratory physician noted in February 2026 that Thomas had made strong progress over the previous month, was eating more, walking more, and that it was certainly possible he could ultimately be decannulated. He cannot fully liberate from the ventilator due to central sleep apnea, which is where his increased CO2 is coming from, but daytime liberation from the ventilator is progressing.

 

Here is the key clinical insight. A patient who is hemodynamically stable, cognitively intact, tolerating a tracheostomy collar for hours during the day, eating orally during the day, standing and walking with assistance, and requiring only nocturnal ventilator support is not an ICU patient. They are a home ICU nursing patient — if the right Intensive Care at Home nursing team is in place. They need an ICU structure around them, which means they need ICU nurses and an ICU doctor overseeing, but they do not need to be in an ICU.

 

What 24/7 Intensive Care Nursing at Home Actually Looks Like for a Patient Like Thomas

At Intensive Care at Home, we provide exactly the nursing model that a patient like Thomas requires. Our nurses are exclusively critical care registered nurses, not general nurses, not personal care workers, not enrolled nurses. These are ICU-trained clinicians who know how to manage:

• Tracheostomy care, stoma care, inner cannula changes, cuff pressure management
• Scheduled as well as emergency tracheostomy changes
• Tracheostomy suctioning, dressing changes, and tracheostomy tape changes
• Nebulizer delivery safely
• Cough assist machine attachment to a tracheostomy
• Nocturnal invasive mechanical ventilation — circuit checks, alarm responses, mode management, weaning progression
• Non-invasive ventilation such as BiPAP, CPAP, AVAP and VPAP during daytime capping trials
• Passy Muir speaking valve use and monitoring
• PEG tube feeds and medication administration
• Dysautonomia management — blood pressure monitoring, positioning, and medication titration
• Airway suctioning and pulmonary hygiene
• Blood glucose monitoring and insulin sliding scale
• Coordination of IV immunoglobulin infusions at home
• Facilitating physiotherapy, occupational therapy, and speech pathology visits at home
• Emergency responses — we carry emergency airway equipment at all times and our nurses are trained in advanced airway management, but more importantly, our nurses are trained to prevent emergencies in the first place

 

Our clinical model is built on our evidence-based Mechanical Home Ventilation Guidelines, which set out exactly how we support patients like Thomas safely at home. These guidelines are informed by literature that was first developed in Germany, because Germany was the first country that really rolled out Intensive Care at Home services on a large scale. We used those evidence-based mechanical ventilation guidelines to set up Intensive Care at Home here in Australia in 2012, and we have been operating ever since. The evidence-based Mechanical Home Ventilation Guidelines bring gold standards in the community when it comes to Intensive Care at Home nursing, and they have served us and our clients very safely ever since.

 

Why Home Is Much Safer Than Long-Term ICU or a Nursing Home or in the U.S would be an LTAC.

This is the conversation that most discharge planners, doctors, and families do not have but it is the most important one.

 

Think about what happens to a ventilator-dependent patient in an ICU. The nursing staff are ICU-trained and they manage tracheostomy and ventilation in the ICU. If Thomas’s tracheostomy becomes dislodged at 2:00 a.m. in the ICU, the response time and clinical skills available to manage the emergency are readily available and it is the same that we can deliver at home. That is why we can easily transfer a patient from the ICU to home, because the same skill is available at home with our 24/7 critical care registered nurses. It is just applying what happens in an ICU to a home care environment, same safe parameters, just in a much more patient and family-friendly environment.

 

That means Thomas will have an intensive care nurse available at all times — awake, monitoring, responding. That is the fundamental requirement to take patients home. The same safety profile as in an ICU, where one nurse covers Thomas 24 hours a day and has all the advanced ICU airway skills.

Those same skills are not available if patients go to nursing homes, it is simply not happening, and people have died under that model, and I have made videos about that many times unfortunately.

 

Let’s look at more Safety Advantages of Intensive Care at Home Nursing at Home

• One-to-one nurse-to-patient ratio, 24 hours a day, no shared care
• Critical care registered nurses with advanced airway and ventilation management training
• Emergency airway equipment always present at the bedside or even during community outings
• Immediate recognition and response to deterioration — no delay waiting for a call bell to be answered
• Consistent nursing team who knows the patient and the family deeply. We create a team that you as a family know, like, and trust
• Reduced medication and care errors
• Infection control, any home care environment carries far lower risk of hospital-acquired infections than any institutional setting
• Autonomic instability managed proactively with real-time monitoring rather than reactive ward checks

Let’s not forget about: The Financial Case — Home Is Dramatically Cheaper

Here is something that surprises many families and funding bodies when I present it. 24/7 specialized home nursing is substantially less expensive than keeping a ventilator-dependent patient in an ICU or in a step-down ICU in a hospital.

 

An ICU bed in most Western countries such as the U.S., UK, Canada, and Australia costs $5,000 to $10,000 per bed day, depending on location and diagnosis. Intensive Care at Home cuts that cost by about 50% — so a $5,000 to $10,000 ICU bed, we can provide for roughly 50% of that cost at home, while providing far better quality of life to patients and families. More importantly, we free up the most sought-after bed in a hospital, which is the ICU bed.

 

Again, this is what our Intensive Care at Home model with providing 24-hour critical care registered nurse support is funded through NDIS, Department of Veterans’ Affairs (DVA), Transport Accident Commission (TAC), WorkSafe, private health funds, departments of health, or sometimes hospitals directly depending on the patient’s circumstances. It costs consistently less than institutional care while delivering superior clinical outcomes and, most importantly, quality of life.

Keeping a patient like Thomas in an ICU costs the healthcare system more money per day than delivering the same care at home with specialized ICU nurses, and delivers worse quality of life, not only for the patient but also for the families. It is not a trade-off. Home is better clinically, economically, and it is evidence-based.

 

What Does Quality of Life Look Like at Home for Thomas or for anybody that is in a similar situation

Thomas as I said before is cognitively intact. He communicates clearly with his Passy Muir speaking valve. He is alert, interactive, directing his own care, asking to go on the tracheostomy collar to eat dinner, asking to be placed back on the ventilator when he is tired. He is a person making active decisions about his own body and his own comfort.

 

In a nursing home or LTAC, that autonomy is constrained by institutional routines, staffing ratios, visiting hours, and the general dehumanizing reality of living in an ICU or in an institution. At home, Thomas could wake up in his own bedroom. His family could be with him without any restrictions. His meals, his schedule, his environment, all of that is his own.

 

The research on home mechanical ventilation consistently shows that quality of life is significantly better at home than in institutional settings, even for patients with intensive care and high care needs. That is exactly why I created Intensive Care at Home because our own outcomes at Intensive Care at Home across over 14 years and over 150 critical care registered nurses operating across five Australian states reflect this evidence, and our clients can vouch for that.

 

Another thing people forget because it seems to be so far removed when patients are in an institution is that pretty much all of our clients have community access. So what that means is, our clients go out. They go to the shopping mall, they go to the movies, they go and visit friends and families, they go to church, they go wherever gives them enjoyment. Compare that to an institution where the highlight of the day might be to sit next to a window. It is very depressing and dehumanizing. But the good thing is that, with Intensive Care at Home, we can make all of that happen and get your family member home.

 

Because what families in Thomas’s situation need to know is that, in a situation like Thomas’s, ventilator-dependent with a tracheostomy in situ, being told they need to go potentially to a nursing home or stay in the ICU because there is nowhere else, or even worse, being told the only option is end of life, I want you to know that this is not true by any means.

 

Before you accept a nursing home placement, you should be asking:

• Has a specialist home ventilation nursing service been assessed that is third-party accredited?
• Has a formal home assessment been completed to determine if the home environment can support 24-hour nursing care?
• What funding options are available, NDIS, DVA, TAC, WorkSafe, private health insurance, departments of health, or potentially self-funding?
• Has the patient been given all their medical records to take to an independent clinical review?

I cannot stress the last point enough. Always get all medical records — everything. Discharge summaries, nursing notes, respiratory notes, vital signs, ventilation settings, weaning notes, blood gas results, imaging reports, therapy notes. You need the complete picture to make informed decisions and to advocate effectively for your loved one. We help you with the advocacy every step along the way because otherwise we would not exist as a service.

 

Also what is important to know is that Intensive Care at Home, we are the only third-party accredited Intensive Care at Home nursing service in Australia in 2026. We hold ISO 9001:2015 certification and NDIS registration. We achieved zero non-conformances in our previous audits which is the highest possible result. We operate all around Australia in all major capital cities, in all regional and rural areas, and in all states and territories. You can learn more about our third-party accreditation at intensivecareathome.com/accreditation_quality.

 

How to Get the Right Help Now

If you are a family member, a patient, or a clinician with questions about whether a ventilator-dependent patient can go home with 24/7 critical care registered nurse support, reach out to us at www.intensivecareathome.com. Call us on one of the numbers on the top of our website or send me 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 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.