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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 at home, where we provide tailor-made solutions for long-term ventilated adults and children at home on bilevel positive airway pressure (BiPAP), continuous positive airway pressure (CPAP) ventilation, non-invasive ventilation, where we provide tailor-made solutions for tracheostomy adults and children without ventilation. We provide ventilation weaning at home, cough assist management at home, as well as tracheostomy weaning at home, home total parenteral nutrition (TPN), home intravenous (IV) fluids, home IV antibiotics, home IV potassium, IV magnesium, and other electrolyte infusions at home, home central line, PICC (Peripherally Inserted Central Catheter) line, Hickman’s line, and port management at home. Nasogastric tube, nasojejunal tube, indwelling catheter (IDC), suprapubic catheter (SPC), percutaneous endoscopic gastrostomy (PEG), and percutaneous endoscopic jejunostomy (PEJ) tube management at home, as well as palliative care management at home. We are also providing level 2 and level 3 National Disability Insurance Scheme (NDIS) support coordination, as well as Transport Accident Commission (TAC) case management.

 

Today, I want to answer a question from Ida, who says,

 

“Hi Patrik, 

My mom is 84 years old with pulmonary hypertension, scleroderma, and congestive heart failure. The ventilator is at 60% oxygen, so she needs it to breathe. They tried weaning for only 1.5 hours. The doctors want to move her to hospice at this point or do a slow wean, but the weaning has now stopped because she seems too weak. Are there any other options besides hospice, or should we agree to the slow wean? Please help, from Ida.”

 

This is a situation here that I see far too often because there is a third option that almost nobody in the hospital system tells families about, not straight away anyway.

 

Before I answer Ida’s question, you might be wondering what makes me qualified, answering questions for families in intensive care and about Intensive Care at Home. I have worked in critical care nursing for over 25 years in three different countries, where I worked as a nurse manager for over five years in intensive care. I was part of successfully setting up 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.

 

We are actually the only third-party accredited and NDIS registered provider for Intensive Care at Home nursing. We have built the intellectual property, and we have the staff to make it all happen.

 

Let us now look at Ida’s questions and answers, of course, in more detail.

The medical team attempted one wean for only a few minutes. It only lasted an hour, as a matter of fact, before it had to be stopped, and now the hospital is only presenting two options: move her mom to hospice or attempt a long, slow wean. Ida asked me if there is anything else that should be considered.

 

Let us start with the clinical picture and understand the clinical picture.

 

Pulmonary hypertension, scleroderma, and chronic heart failure on a ventilator, and this is a genuinely complex combination, and it is worth explaining why it makes weaning so difficult.

 

Pulmonary hypertension means pressure in the blood vessels of the lungs is abnormally high, which puts strain on the right side of the heart. Scleroderma commonly causes lung fibrosis, which stiffens the lungs and increases the work of breathing. Congestive heart failure on top of that means the heart is already struggling to pump efficiently.

 

Put those three ingredients together on a ventilator, and you have a patient whose lungs are stiff, whose heart is under strain, and whose oxygen requirements of 60% tells us the lungs are not exchanging oxygen well at baseline.

 

A 90-minute weaning trial in this context is a very short window. Weaning from a ventilator, especially in a patient with this combination of conditions, is a gradual physiological retraining process for the respiratory muscles and the heart. It is not something that typically succeeds in a single attempt, measured in hours, particularly in an 84-year-old who has likely been immobile and ventilator-dependent for quite some time.

 

Let us now look at why the wean stopped, the real reasons behind weaning failure.

 

When a wean is stopped because the patient is too weak, that weakness usually has an identifiable, addressable cause. In my clinical experience, the most common contributors are:

1.  ICU-acquired weakness and muscle deconditioning from time spent sedated, immobile, or critically unwell.

2. Right heart strain from pulmonary hypertension, which limits how much extra cardiac work the patient can tolerate during a ventilation wean.

3. Restrictive lung disease from scleroderma, which increases the effort of every breath.

4. Nutritional deficits, which are extremely common in long ICU admissions and directly affect respiratory muscle strength.

5. A weaning protocol that is simply too fast for this particular patient’s physiology.

The key point I want families to understand is this: the wean failed does not automatically mean weaning is impossible.

It often means the wean needs to be slower, more structured, and supported by a team with the time and clinical expertise to do it properly, something a busy hospital ICU is not always resourced or equipped for.

 

Let us now look again at options: hospice, slow wean, or Intensive Care at Home. Ida was told there were only two options. I want to respectfully offer a third option, continuing ventilation support and rehabilitation at home with Intensive Care at Home, with dedicated 24-hour critical care registered nurses rather than in an ICU or a hospice. A hospice, generally speaking, means shifting the goals of care to comfort and end of life rather than recovery. That is the right choice for some families, but it should be a decision made with full information and without time or bed pressure influencing it.

 

Number two, a slow wean in hospital can work, but hospital wards and ICUs are not resourced for the kinds of unhurried, one-on-one, day-after-day rehabilitation that a genuinely gradual weaning requires.

 

Number three, Intensive Care at Home means your mom can be cared for by 24-hour critical care registered nurses (CCRNs) at her own home, on the ventilator via her tracheostomy, with the option of continuing a properly paced weaning program in a calmer, less clinical, more dignified environment without giving up on recovery.

 

This is not a theoretical option.

 

Our weaning and long-term ventilation protocols at home are based on published evidence-based mechanical home ventilation guidelines, which you can read in full by clicking on the link that I put in the show notes. Families and clinicians are welcome to review the evidence themselves before making a decision this significant.

 

Ida, I want to also acknowledge you directly because reaching out and asking whether there are other options besides hospice or a slow respiratory wean at the moment, as frightening as this is, is exactly the right instinct.

 

Too many families in intensive care accept the first two options they are given because they do not know a third one exists or because they are worried about pushing back on a medical team. You did not do that. Advocating for your mom like this, questioning the plan, seeking a second perspective, is precisely what changes outcomes in situations like your mom’s situation. Whatever you and your family ultimately decide, know that asking this question is the right thing to do.

Before any final decision is made between hospice and continued ventilation weaning, I strongly encourage you to request your mom’s full medical records.

Start with doctors’ reports, nursing reports, ventilator charts, vital signs, magnetic resonance imaging (MRI) scan reports, computed tomography (CT) scan reports, medication charts, lab results, fluid balance charts, medication charts. Leave no stone unturned because these medical records tell the real clinical story, often in way more detail than a bedside conversation can.

 

If you would like help interpreting the medical records so you can ask the treating team sharper, more informed questions, or if you want me and my team to ask those questions to the clinical team, that is exactly what me and my team does in the consulting work that we provide as well.

 

If you are facing a decision like Ida, you do not have to work this out alone or rely only on a five-minute hallway conversation with a busy ICU team that might just say to you, we think it is best for her to go to hospice.

 

The biggest challenge for families in intensive care is simply that they do not know what they do not know. They do not know what to look for. They do not know what questions to ask. They do not know their rights, and they do not know how to manage doctors and nurses in intensive care.

 

We will help you exactly understand what your mom’s condition means, what the numbers mean, what your realistic options are, and how to advocate for her effectively if you want to bring her home.

 

If you then want to continue ventilation support and rehabilitation outside of a hospital with Intensive Care at Home, that is exactly what we do here, obviously, at Intensive Care at Home, and what it was built for.

 

We provide a genuine alternative to a long-term stay in ICU by providing 24/7 care with critical care registered nurses for patients, adults and children, who are ventilator-dependent with a tracheostomy or who are on non-invasive ventilation such as BiPAP or CPAP, or who need a tracheostomy at home without ventilation in the client’s own home, surrounded by their families, and that is for adults and for children.

 

What sets Intensive Care at Home apart is really the level of third-party accreditation.

 

Intensive Care at Home is Australia’s only third-party accredited specialist home intensive care nursing provider, independently audited by International Organization for Standardization (ISO) for ISO 9001:2015, and also for NDIS registration. We have created and developed the policies and the procedures and the intellectual property needed to provide Intensive Care at Home nursing at home.

 

That enables us to employ hundreds of years of critical care nursing experience combined. That means we have the workforce, the teams that bring the intensive care into your home when needed.

 

You can review our accreditation and quality standards on our website at intensivecareathome.com/qualityaccreditation, and I will link to it in the show notes.

 

For a patient like Ida’s mom, that can mean the difference between a rushed 90-minute wean attempt in a busy ICU or a properly paced, closely monitored weaning and rehabilitation program at home run by ICU nurses who specialize in exactly this.

 

The bottom line is this, Ida: a failed 90-minute wean attempt in a patient with pulmonary hypertension, scleroderma, and congestive heart failure is not proof that weaning can never succeed, and it does not mean hospice is the only remaining path.

 

Before agreeing to either hospice or a slow hospital and ICU wean, get the full medical records, ask what specifically caused the weaning failure, and find out whether a properly paced program delivered by Intensive Care at Home with 24-hour critical care registered nurses is realistic for your mom.

 

You deserve full information and real options, and I am here to get your help for both. Keep in mind that the hospital should not be rushing towards withdrawing treatment for your mom and getting her to hospice. The hospital should be saving your mom’s life and see what happens instead of rushing to kill your mom in hospice. There should be a rush and an urgency to help your mom to the best of their abilities.

 

Always ask yourself the question in a situation like that: where is the rush to let someone’s life go? Where is the rush to kill someone? Why is there no rush to help someone? Always ask that question.

 

You can contact me here at intensivecareathome.com.

 

We are currently operating all around Australia in all states and territories, in all regional, rural, and metro areas.

 

Contact us at intensivecareathome.com, call us on one of the numbers on the top of our website, or simply schedule a call with me.

 

There is a schedule appointment button on the website, or send us an email to info@intensivecareathome.com, or you can reach me on my mobile phone, 041 094 2230 here in Australia.

 

You can also call me on one of our international numbers if you are in the United States, in Canada, in the United Kingdom, India, anywhere around the world, and you want Intensive Care at Home. Please contact us as well. We can help you there as well.

 

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.