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My name is Patrik Hutzel from intensivecareathome.com where we provide tailor-made solutions for long-term ventilated adults and children with tracheostomies, where we provide tailor-made solutions for long-term ventilated adults and children on BiPAP (Bilevel Positive Airway Pressure) and CPAP (Continuous Positive Airway Pressure). We provide 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 IV fluids, home IV antibiotics, home IV (intravenous) potassium, home IV magnesium infusions, central line, PICC (Peripherally Inserted Central Catheter) line, Hickman’s line, as well as port management at home. IDC (Indwelling Catheter) and SPC (Suprapubic Catheter) management, PEG (Percutaneous Endoscopic Gastrostomy) tube, PEJ (Percutaneous Endoscopic Jejunostomy) tube, nasogastric tube, nasojejunostomy tube, as well as palliative care management at home.

 

I recently spoke with Andrew, whose 72-year-old wife had open-heart surgery four weeks ago. She came out of surgery on ECMO (Extracorporeal Membrane Oxygenation), was then placed on a mechanical ventilator with a tracheostomy, and has been in the ICU ever since. The hospital wants to discharge her to an Acute Care Facility or to a step down ICU but she doesn’t yet have a PEG tube — a surgical feeding tube placed through the abdominal wall due to concerns about bleeding risk around her recently implanted pacemaker.

 

Andrew found my website and reached out. He wanted to know: can we take her home instead?

 

The answer, in cases like this, is often yes, but the devil is in the details. This is a situation I see regularly. Complex cardiac patients who have been in the ICU for weeks, who are slowly deconditioned, who are on a ventilator with a tracheostomy, and whose families are desperately looking for a better path than an Acute Care Facility or step down ICU. Let me walk you through everything you need to understand about this situation.

 

What Happened to Andrew’s Wife And Why It Is More Common Than You Think

Open-heart surgery in a 72-year-old is a major physiological event. When complications arise as they did here, the recovery trajectory can be long and unpredictable. In Andrew’s wife’s case, the timeline looked like this:

 

Week 1 post-surgery: ECMO (Extracorporeal Membrane Oxygenation) support — the most intensive form of cardiac and respiratory support available

Week 2: Still mechanically ventilated via an endotracheal tube (breathing tube through the mouth)

Week 2–4: Tracheostomy placed, ventilator weaning attempted, pacemaker implanted for cardiac arrhythmia

Now (week 4): Still on low-level pressure support ventilation, losing muscle mass, deconditioned, medically stable but mentally struggling

 

This is ICU-acquired weakness in action. The longer someone stays in an ICU bed, the more muscle mass they lose — including the muscles they need to breathe independently. It becomes a self-reinforcing cycle: prolonged ICU stay causes weakness, weakness prevents ventilator weaning, inability to wean prolongs the ICU stay.

The hospital and the insurance company are caught in a standoff over a PEG tube. But the family is exploring a third option: going home with specialist nursing support. And that is exactly where I come in.

 

KEY CLINICAL FACTS ABOUT ANDREW’S WIFE

• Age: 72

• Procedure: Open-heart surgery (complex, prolonged)

• Post-operative course: ECMO x 1 week, ventilated via ETT, tracheostomy at week 2

• Current status: Ventilator-dependent (low pressure support), tracheostomy in situ

• Complication: New pacemaker (implanted last Friday), PEG tube deferred due to bleeding risk with heparin

• Nutrition: Currently via nasogastric tube

• Hospital plan: Acute Care Facility when PEG tube placed or step down ICU

• Family preference: Home care

 

Why Acute Care Facility or step down ICU Is Not the Only Option — And May Not Be the Best One

Acute Care facilities market themselves as specialists in ventilator weaning. Andrew mentioned this is what the hospital told him. But here is something families almost never know:

 

 

The evidence does not consistently show that Acute Care Facilities or step down ICU produce better ventilator weaning outcomes than well-resourced home environments — particularly for patients who are already on low ventilator settings and are medically stable.

 

What Acute Care Facility and step down ICU’s do provide is around-the-clock nursing in a hospital-like environment. But so does Intensive Care at Home — with one critical difference. At home, your loved one is in a familiar environment, surrounded by family, sleeping in their own bed, and not being exposed to the hospital-acquired infections, noise, and institutional stress that compound ICU-acquired deconditioning.

 

Family presence is not just emotionally beneficial. It is clinically significant. Patients who recover in home environments, with strong family support and specialist nursing, often show faster progress with rehabilitation, better psychological wellbeing, and improved appetite and nutrition compliance.

 

WHAT FAMILIES NEED TO UNDERSTAND ABOUT ACUTE CARE FACILITIES

Acute Care Facilities are not ICUs. They provide a step-down level of care. If your loved one deteriorates, they will be transferred back to an acute hospital — just as they would be from a home care setting.

 

Acute Care Facility ventilator weaning ‘expertise’ varies enormously by facility.

Acute Care Facilities are institutional environments. They come with all of the psychological and physical downsides of hospitalization — without the intensity of ICU nursing.

 

The cost of Acute Care Facility or step down ICU care to the healthcare system is enormous. Home-based intensive care is frequently more cost-effective, which is why NDIS (National Disability Insurance Scheme), TAC (Transport Accident Commission) and DVA (Department of Veterans’ Affairs) and some private insurers support it.

 

Can a Patient on a Ventilator With a Tracheostomy Go Home? Yes — Here Is What Is Needed

 

The short answer is yes, in the right circumstances. Our evidence-based Mechanical Home Ventilation Guidelines outline exactly what is required for a safe transition from ICU to home for a ventilator-dependent patient. Here is what needs to be in place:

 

Medical stability: No ongoing acute deterioration — Andrew’s wife meets this criterion

Ventilator settings that are manageable in a home environment: Low pressure support ventilation can often be delivered at home with the right equipment

Tracheostomy management: Our CCRNs are specialists in tracheostomy care, suctioning, inner cannula changes, nebulizer management and emergency tracheostomy management. More importantly they are trained to prevent emergencies.

Nutrition: An NGT is manageable at home; a PEG tube is preferable for long-term feeding but is not always a prerequisite for discharge

Specialist nursing: 24/7 CCRN coverage — not enrolled nurses, not personal care workers, but actual Critical Care Registered Nurses

Appropriate home environment: A ground-floor room or accessible bedroom, power supply for ventilator and equipment, and proximity to emergency services

Clear escalation and emergency plan: Who to call, when to call, and when to activate emergency services

You can read our full Mechanical Home Ventilation Guidelines to understand the clinical standards we apply to every patient we assess.

 

The PEG Tube Question — Is It Actually a Barrier to Going Home?

In Andrew’s case, the hospital is delaying both the Acute Care Facility and step down ICU transfer and any discharge because they want a PEG tube placed before she leaves. The reason for the delay is legitimate from a surgical risk perspective: her pacemaker was only implanted five days ago, and placing a PEG tube requires heparin anticoagulation, which carries a bleeding risk around the fresh pacemaker pocket.

 

But here is what Andrew needs to understand:

A nasogastric tube (NGT), which his wife already has, can support nutrition at home. It is not ideal for long-term use, but it is clinically manageable under specialist nursing supervision.

 

The PEG tube question will likely resolve within days to weeks as the pacemaker site heals. This is not a permanent barrier.

 

Going home with an NGT and transitioning to a PEG tube after discharge — if and when it is clinically appropriate — is a legitimate clinical pathway.

The key question is not “does she have a PEG tube yet?” The key question is: “Is she medically stable, and can her care needs be safely met at home with the right team?”

 

WHY INTENSIVE CARE AT HOME IS DIFFERENT

We are Australia’s ONLY third-party accredited specialist Intensive Care at Home nursing provider.

 

We are ISO 9001:2015 and NDIS Quality and Safety Commission certified — independently audited by BSI Group (December 2025, zero non-conformances).

All our nurses are Critical Care Registered Nurses (CCRNs) — not enrolled nurses or personal care workers.

 

We operate across all states and territories within Australia.

We provide 24/7 nursing support, specialist clinical governance, and direct line to our clinical team at all times.

 

Learn more about our accreditation: intensivecareathome.com/accreditationquality

 

What Andrew Needs to Do Right Now — A Step-by-Step Action Plan

If you are in Andrew’s situation — your loved one is in the ICU, the hospital is pushing Acute Care Facility, the insurance company is being difficult, and you want to explore going home — here is what I told Andrew, and what I am telling you:

Step 1: Get Access to the Medical Records

Ask the hospital to give you authorized proxy access if your loved one cannot access it themselves. You are looking for:

Current ventilator settings (mode, pressure support level, FiO2 (Fraction of Inspired Oxygen), PEEP (Positive End Expiratory Pressure)

Current medication list

Most recent clinical notes and prognosis documentation

Nursing and respiratory therapy care plan

 

Step 2: Request a Family Conference With the ICU Team

Ask specifically to speak with the ICU consultant, the respiratory physician, and the social worker or discharge planner. Tell them you are exploring home care as an alternative to Acute Care Facility and ask for their clinical input on what would need to be in place for a safe home discharge.

 

Step 3: Contact Intensive Care at Home or Intensive Care Hotline for a Consultation

This is where I can help you directly. Book a one-hour consulting call with me and share the medical record summary. I will review the ventilator settings, medications, and clinical status and give you a clear answer: can she go home, and what would it take? I have done this hundreds of times. I will not waste your time.

 

Step 4: Start the Conversation With the Insurance Company

Do not wait for the hospital to do this on your behalf. We can ask the insurers what their criteria are for approving home care for a ventilator-dependent patient. We can ask whether they cover home nursing for a patient with a tracheostomy and mechanical ventilation. Get the answers in writing but we can also do it for you.

 

Do Not Sign Anything at the Hospital Without Understanding Your Options

Hospitals are under enormous pressure to discharge patients. They will push for the path of least resistance, which is usually Acute Care Facility. You have the right as a family to advocate for a different plan. Do not feel pressured into a decision that does not serve your loved one’s best interests.

 

The ICU Advocacy Principle: You Are Your Loved One’s Best Advocate

One of the most important things I have learned in 25+ years in intensive care is this: the families who get the best outcomes for their loved ones are the ones who ask questions, seek independent advice, and refuse to accept the default institutional path without exploring the alternatives.

 

Andrew did exactly the right thing. When the Acute Care Facility transfer got blocked, instead of waiting passively, he got on a call with me the very next day and started exploring whether his wife could come home. That kind of proactive advocacy makes a real difference.

 

Your loved one cannot advocate for themselves when they are on a ventilator. That is your job. And I am here to help you do it.

 

REAL QUESTIONS FAMILIES ASK ME — AND MY HONEST ANSWERS

“Is home care safe for someone still on a ventilator?” Yes — with the right specialist nursing team, the right equipment, and the right clinical governance, it is not only safe, it is often safer than an Acute Care Facility environment where nursing ratios may be lower and infections are a constant risk.

 

“What if she deteriorates at home?” We have a clear escalation pathway but more importantly we know how to prevent emergencies. Our nurses are CCRNs trained to prevent and manage deterioration. We call ED’s or an ambulance when needed. Home care is not ‘set and forget’ — it is intensive clinical care delivered in a different setting.

 

“Can we manage a tracheostomy at home?” Yes. Tracheostomy management — including suctioning, inner cannula care, and emergency management — is a core competency of every nurse on our team.

 

“What if she still needs the PEG tube?” A PEG tube can be placed as an outpatient or planned procedure after discharge, once the pacemaker site has healed. The NGT can support nutrition in the interim under our clinical supervision.

 

How Intensive Care at Home Works — Our Model of Care

Intensive Care at Home provides specialist home nursing for ventilator-dependent patients across Australia. But even if you’re in the USA, UK or Canada we can help you. Our model is simple: we bring the ICU to your home. Here is how it works:

Initial assessment:

We review the medical records, speak with the ICU team, and assess the home environment.

Clinical care planning:

Our Clinical Operations Manager and clinical team develop a bespoke care plan, including ventilator management, tracheostomy care, medication management, nutrition, and rehabilitation.

Equipment:

We coordinate all required medical equipment — ventilators, suction machines, humidifiers, monitoring equipment, and emergency supplies.

24/7 CCRN nursing:

Our nurses provide intensive nursing care in the home. We do not use agency nurses. Our team is directly employed and clinically supervised.

Ongoing clinical governance:

Our clinical governance structure — underpinned by our ISO 9001 and NDIS accreditation — ensures consistent quality and safety.

You can read about our accreditation standards here: intensivecareathome.com/accreditationquality.

 

How to Work With Us — Three Ways I Can Help You Right Now

 

Final Thoughts: The ICU Is Not the Only Option

If your loved one is on a ventilator with a tracheostomy, medically stable, and the hospital is pushing Acute Care Facility, please know this: going home with specialist INTENSIVE CARE AT HOME nursing support is a real option. It is not a radical or risky choice. It is an evidence-based, clinically valid alternative that hundreds of families have chosen — and that has transformed lives.

 

The ICU is a place for acute treatment and stabilization. Once your loved one is medically stable, the goal should be to get them out — ideally to the environment where they are most likely to thrive. For most people, that is home.

 

If you are in Andrew’s situation right now, do not wait. Get the medical records. Ask the questions. Call us. We are here to help.

 

We also provide level 2 and level 3 NDIS support coordination as well as TAC and WorkSafe case management.

 

? Call us in Australia: 1300 921 536 | +61 3 8658 2138

USA/Canada 415-915-0090

UK 0118 324 3018

? Visit us: http://intensivecareathome.com  

? Mechanical Home Ventilation Guidelines: intensivecareathome.com/mechanical-home-ventilation-guidelines

? Accreditation & Quality: intensivecareathome.com/accreditationquality

 

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), Home CPAP (Continuous Positive Airway Pressure) ventilation without tracheostomy
• Tracheostomy care without ventilation
• Home TPN 
• 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.