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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 on bilevel positive airway pressure (BiPAP), continuous positive airway pressure (CPAP), non-invasive ventilation at home without tracheostomy, where we provide tailor-made solutions for tracheostomy adults and children at home without ventilation. Home ventilation weaning, home tracheostomy weaning,  home cough assist management, home total parenteral nutrition (TPN), home intravenous (IV) fluids, home IV antibiotics, home IV potassium, home IV magnesium, and other electrolyte infusions at home, that goes along with central line, PICC (Peripherally Inserted Central Catheter) line, Hickman’s line, and port management at home. , Indwelling catheter (IDC), suprapubic catheter (SPC management at home, nasogastric tube, Naso jejunostomy tube management at home, 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.

 

Here is a question from Debbie:

 

I want to read out her question, explain why her advocacy matters, and speak directly to Debbie.

 

Debbie, what you are doing for your dad right now is exactly the kind of advocacy that changes outcomes for critically ill and long-term ventilated patients in ICU (Intensive Care Unit). For most families here, the oxygen needs are too high, and there is nothing else that can be done from a hospital’s perspective. They accept it because the hospital is the expert and the family is exhausted, scared, and out of their depth. You did not accept that — you went looking for another option. That single decision to keep asking, “What else can we do?” is very often the difference between a loved one spending months stuck in a hospital or ICU bed, and a loved one going home to recover in familiar surroundings, with family, with dignity, and with a real shot at improvement.

 

Well done, Debbie. Let’s go through your question properly.

 

Here is Debbie’s email in full:

 

“Hi Patrik, 

 

I’m trying to help bring my father home from the hospital. He’s currently on 60% FIO2 (Fraction of Inspired Oxygen) in ICU and has a tracheostomy placed while recovering from several hospital-acquired pneumonias. The ICU says his oxygen needs are too high for him to go home or even to a rehabilitation facility, and they don’t know if he will improve. He’s otherwise able to move around and he’s alert and oriented. My question is, there has to be something else we can do besides keeping him in ICU. Please advise how we can get him home with Intensive Care at Home. 

 

From Debbie.”

 

Before I break down Debbie’s dad’s clinical picture, you might be wondering what makes me qualified to speak on this topic. I have worked in critical care and ICU 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 setting up intensive care at home services in Germany in the early 2000s, and I brought the concept to Australia in 2012. We have been running Intensive Care at Home since 2012, and we are the only third-party accredited and NDIS-registered provider for intensive care at home nursing in Australia.

 

I am also the founder of intensivecarehotline.com, where we provide consulting and advocacy for families in intensive care. You can find more information at intensivecarehotline.com.

 

Debbie’s Dad’s Clinical Picture

 

Let’s look at exactly what we’re dealing with, because the details Debbie has shared paint a far more encouraging picture than the ICU’s “there’s nothing else we can do” framing suggests.

 

Number one: 60% FIO2. This is elevated, yes, but it is a long way from 80% or 100%. I see families’ emails where a patient is truly at the outer limits of what any setting — home or hospital — can safely manage. In an ideal world, before going home, you want to get that FIO2 down to at least 40%, ideally 30% and below, but that is not always possible. It comes down to clinical governance, resource management, and a lot to mindset, which I’ll talk about in more detail.

 

Number two: the tracheostomy is in place. This tells me the medical team has already accepted this is a longer-term recovery, not a quick extubation. That is useful information for planning, not a red flag.

 

Number three: recovering from several hospital-acquired pneumonias. This is critical context. Hospital-acquired and ICU-acquired pneumonias are, by definition, infections acquired in hospital. The longer a person with a tracheostomy stays in an acute hospital bed, the higher their ongoing risk of picking up another one.

 

Number four: your dad is alert, oriented, and able to move around. In my 25-plus years of ICU nursing in three different countries, this is one of the single biggest and best prognostic indicators. A patient who is alert, oriented, and mobile with a tracheostomy is a patient who can actively participate in their own weaning, physiotherapy, and recovery. That is not a patient who is too sick for a home care model — that is a patient who is an excellent candidate for a home care model, as long as everything else can be optimized, including reducing FIO2 to ideally 40% or below.

 

Why Is the ICU Saying It’s Too High for Home or Rehab?

 

When an ICU or hospital tells a family “He’s too high on oxygen for home or rehabilitation,” what they usually mean is he is too high for the standard staffing model at a typical rehab facility, or for a home care package built around a support worker or basic community nursing visits. That is a completely different statement to “it is not medically possible for him to be cared for at 60% FIO2 outside of an acute care hospital.”

 

Most inpatient rehab facilities are not set up for tracheostomy patients requiring 60% FIO2, because they do not have 24-hour critical care registered nurses rostered around the clock. Standard home care agencies are the same — they are built around support workers and periodic nurse visits, not 24/7 ICU-level nursing with ICU consultant oversight. So the hospital is not entirely wrong that their two default options — general rehabilitation or a basic home care package — are not appropriate. Where they are wrong is stopping the conversation there, instead of telling families that a third option exists: 24-hour critical care registered nurse–led care at home, which is exactly what we do at Intensive Care at Home.

 

Treatment and Care Options

 

Here is what I would be asking the medical and nursing team, and what a genuine plan for Debbie’s dad should include:

 

Number one: a clear oxygen weaning plan. What is the target FIO2 trajectory, and what is actually being done day to day to trend it down? Weaning stalls in ICUs and hospitals far more often than families are told, simply because even ICU staff can be stretched thin.

 

Number two: ongoing treatment of the underlying hospital-acquired pneumonias. Repeated infections need a clear antibiotic and secretion management plan, not just wait-and-see.

 

Number three: tracheostomy and airway management — suctioning, humidification, and secretion clearance done consistently and safely, which is exactly the kind of hands-on, task-heavy care that gets diluted on a busy general ward.

 

Number four: active mobilization and physiotherapy. Because he is already alert, oriented, and mobile, this should be ramping up, not sitting static in a hospital bed.

 

Number five: a genuinely individualized home care plan led by 24-hour critical care registered nurses — not general registered nurses, not community registered nurses, and definitely not support workers — so that the 60% FIO2 (and ideally lower), tracheostomy, and infection risk are managed at the same clinical standard he is getting in an ICU, including medical oversight, which we can provide. And this care would take place in his own home, away from the very environment where he picked up multiple infections in the first place.

 

This is precisely the model of care we have built our evidence-based approach around at intensivecareathome.com. If you want to see exactly how we structure safe home mechanical ventilation and 24/7 high-acuity tracheostomy care with critical care nurses — including staffing ratios, escalation-avoidance, escalation pathways, and equipment standards — have a look at our evidence-based mechanical home ventilation guidelines. The link is in the show notes.

 

Requesting the Medical Records

 

Debbie, one of the most powerful things you can do right now is request your dad’s full medical records and current care plan in writing. Do not rely on verbal updates or hallway conversations. Ask specifically for:

 

Number one: current trending FIO2, oxygen saturations, respiratory rate, arterial blood gases, and ventilator or tracheostomy collar settings over the past one to two weeks.

 

Number two: the formal weaning plan, if one exists, and who is accountable for it.

 

Number three: details of each hospital-acquired pneumonia episode and the treatment given.

 

Number four: the discharge planning notes that state he is too high for rehab or home, including exactly which criteria and which service type that assessment was based on.

 

Once you have all of this in writing, you are no longer negotiating from a position of “they said so” — you have the actual clinical picture, and that is what lets a service like ours properly assess whether we can safely bring your dad home.

 

Debbie, if you would like me and my team to personally review what’s happening and help you build a plan to get your dad home safely — including how to advocate for funding — here is how we can work together. Call me or my team directly through the website at intensivecareathome.com, call us on one of the numbers at the top of our website, or book a call by clicking the schedule appointment button, or email us at http://intensivecareathome.com   and we will take it from there. If you are in Australia, you can call me on my mobile: 0410 942 230.

 

About Intensive Care at Home

 

This is exactly the kind of situation Intensive Care at Home was built for. Right now, in 2026, we are Australia’s only intensive care at home nursing service that is third-party accredited specifically for intensive care at home nursing. We are accredited against ISO (International Organization for Standardization) 9001:2015, as well as NDIS registered. You can read more about our accreditation and quality standards — the link is in the show notes — at intensivecareathome.com/accreditation-quality.

 

What that means in practice for a family like Debbie’s is simple: the same critical care registered nurse–led standard of care, 24 hours a day, that her dad is getting in ICU — managing 60% FIO2 and trying to get it down, tracheostomy, infection risk, and mobilization — can continue at home instead of stopping the moment he is discharged to a facility that is not equipped for his level of need. Our 24-hour CCRNs (Critical Care Registered Nurses) manage invasive ventilation with tracheostomy, non-invasive ventilation on BiPAP/CPAP without tracheostomy, and tracheostomy care without ventilation, 24/7, in the patient’s own home.

 

The bottom line, Debbie: your dad being on 60% FIO2 with a tracheostomy, while recovering from repeated hospital-acquired pneumonias, does not automatically mean he has to stay in ICU indefinitely or be sent to a facility that would not be the right fit for him. The fact that he is alert, oriented, and mobile puts him in a strong position for a genuine, recovery-focused plan. “Too high for standard rehab or a basic home care package” is not the same as “too high to go home.” Get the medical records, ask the pointed questions, and reach out to us at intensivecareathome.com. Let’s talk about what bringing him home safely could look like, including the funding and who will pay for it. Keep in mind, an ICU bed costs between $5,000 and $10,000 per bed day, and we reduce that cost by around 50%. Funding bodies have an interest in getting the cost down to 50% of an ICU bed while maintaining care standards at home, and hospitals have an interest in freeing up ICU beds for patients who need higher-acuity critical care.

 

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.