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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 BiPAP (Bilevel Positive Airway Pressure) and CPAP (Continuous Positive Airway Pressure), non-invasive ventilation at home, where we provide tracheostomy care at home without ventilation for adults and for children.

 

We do home ventilation weaning when medically appropriate, tracheostomy weaning when medically appropriate. We do cough assist management at home. We do home TPN (Total Parenteral Nutrition), home intravenous (IV) fluids, home IV antibiotics, home IV potassium, magnesium infusions, and other electrolyte infusions, which goes hand in hand with PICC (Peripherally Inserted Central Catheter) line, central line, Hickman’s line, and port management at home, as well as palliative care management at home, which includes indwelling catheter (IDC), suprapubic catheter (SPC) management at home. PEG tube management at home, as well as nasogastric tube and nasojejunal tube management at home.

We are also providing level 2 and level 3 National Disability Insurance Scheme (NDIS) support coordination for NDIS and Transport Accident Commission (TAC) clients and participants.

 

If you are watching or reading this, chances are you are facing the exact situation Frances wrote to me about this week.

 

Here is Frances’ email.

 

“Hi Patrik, 

 

The ICU doctors want my husband off the ventilator and keep him, and she puts in quotes, comfortable.

 

I want him to have a tracheostomy and the PEG.

 

Then I want him to come home with 24-hour ICU nurses to get him out of ICU.

He had a heart attack, then the congestive heart failure, contracted COVID in the ICU.

 

Can you please help with Intensive Care at Home?

 

From Frances.”

 

I hear a version of Frances’ story every single week.

A loved one is critically ill.

 

The ICU team starts using words like comfortable or keep him comfortable, and the family senses that this is code for withdrawing treatment while they themselves are not ready to give up.

 

Before I break it down, exactly what is happening clinically and what your options are, Frances, you might be wondering what makes me qualified to answer questions like that.

 

I have 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 was working with Intensive Care at Home services in Germany in the early 2000s, where I was part of a pioneering service in Germany, and then I brought the concept to Australia in 2012. That is how long we have been operating here with Intensive Care at Home.

 

I am also consulting and advocating for families in intensive care at our sister site, intensivecarehotline.com, and we have delivered millions of hours of Intensive Care at Home nursing by now.

 

Frances, let us see how we can get your husband out of ICU and come home safely with 24/7 critical care registered nursing support.

 

Let us start with the clinical picture: heart attack, congestive heart failure, and hospital-acquired COVID.

 

Based on what Frances has described, here is what has likely happened physiologically.

 

Four points that stand out.

 

Number one, a heart attack, also known as a myocardial infarction, damaged part of the heart muscle, reducing the heart’s pumping ability.

 

Number two, this led to congestive heart failure.

 

The heart cannot pump efficiently, so fluid backs up into the lungs, making breathing harder and often requiring mechanical ventilation.

 

Number three, while in ICU, he then contracted COVID-19, which is nothing but a hospital-acquired, also known as a nosocomial infection, on top of an already compromised cardiac and respiratory system.

 

The combination of heart failure and a respiratory infection makes ventilator weaning genuinely harder and slower, but harder does not mean impossible.

This is exactly the kind of complex multi-system critical illness where I see ICU teams move quickly towards comfort care language, often because a prolonged ICU stay is difficult to manage from a bed flow, staffing, and also financial perspective, not necessarily because there is no pathway forward.

 

That is not a criticism of individual ICU teams or ICU doctors or nurses.

It is a reflection of the system and of how acute hospital ICUs are resourced and incentivized, but it means families in intensive care need to ask the right questions before accepting that a ventilator is coming out and treatment is being withdrawn.

 

Let us now look why a tracheostomy and a PEG make sense here.

Frances is asking for exactly the two interventions I would expect the family to ask for in this situation.

 

Number one is the tracheostomy for patients who need more than two weeks of ventilation with a breathing tube.

 

A tracheostomy is much safer and more comfortable than an endotracheal tube.

It allows sedation to be reduced, makes weaning trials easier to run, protects the airway, and critically for Frances’ goal, is the only realistic way to get a ventilated patient out of an ICU bed into a safe home care environment with Intensive Care at Home.

 

Number two is the PEG, which stands for percutaneous endoscopic gastrostomy.

Once it is clear nutrition will be needed for more than a few weeks or months, a PEG tube is safer and more sustainable than a nasogastric tube, reduces aspiration risk, and is far more comfortable for long-term use, including at home.

Neither of these interventions is giving up. If anything, they are two interventions that make a genuine recovery attempt and a safe discharge home possible. Also, you would have seen videos from me where I advocate against the PEG, so it is definitely not a one-size-fits-all.

 

In this situation, especially with Frances’ goal of getting her husband home, a PEG tube would be the safer option, but it depends on the situation. When I say in other videos, do not do a PEG, it has contextual information why I do not advocate for PEGs in certain situations.

 

Here, I clearly do advocate for a PEG, so it is not a one-size-fits-all. The devil in those situations is absolutely in the detail. Let us look at treatment options and what should be on the table.

 

Number one, a formal documented weaning plan and timeline before any conversation about withdrawal of treatment happens.

 

Ask specifically what weaning trials have been attempted and what the results were.

 

Number two, tracheostomy insertion once ventilation is expected to continue beyond seven to 14 days.

 

Number three, PEG insertion for medium to long-term nutrition.

 

Number four, treatment of the COVID-19 infection and optimization of heart failure management, which is diuretics, cardiac medications, fluid balance run in parallel with weaning.

 

Number five, a second opinion from another intensivist or cardiologist if the family disagrees with the treatment direction.

 

This is your right, and a reasonable ICU team will not obstruct it.

 

Number six, a discharge plan to come home with 24/7 critical care registered nurses with Intensive Care at Home, rather than a long-term ICU or hospital admission or a shift to palliative or comfort care.

 

Let us now also look at what needs to happen next.

 

For example, medical records, advocacy, what you should do right now, Frances.

This is a step families consistently underestimate before you agree to anything and definitely before you agree to withdrawal of treatment conversations or a shift to comfort care, which is a euphemism for end-of-life care.

 

Do the following.

Number one, request copies of all of your husband’s medical records, including doctors’ notes, nursing progress notes, specialist notes, ventilator settings and weaning trial results, vital signs, chest X-ray reports, CT MRI scan reports, family meeting notes, medication list, lab and pathology results including arterial blood gases, fluid balance charts.

 

Leave absolutely no stone unturned.

 

Ask in writing if needed, exactly why the ICU team believes weaning and tracheostomy are not appropriate.

 

Get specific clinical reasoning, not general language like he is not doing well.

Ask what the plan would be if you declined the recommendation to withdraw and instead consent to tracheostomy and PEG.

 

If you feel pressured or rushed, slow down the process. You are entitled to time, to a second opinion, and full information before consenting to anything. We have supported hundreds of families, potentially thousands, through exactly this kind of conversation with ICU teams. We will guide you through this process as well to get your husband home in a safe, more predictable, stable, and permanent environment to keep him out of ICU.

 

Intensive care teams will not necessarily tell families about Intensive Care at Home because most hospitals simply do not know it is an option. Their ventilated or tracheostomized patient does not have to stay in ICU, move to a ward, or go into a nursing home. They can come home with the same level of critical care nursing they are getting in ICU.

 

Here at Intensive Care at Home, we provide 24/7 ICU nurses at home from critical care registered nurses for adults and children with invasive ventilation and tracheostomy, non-invasive ventilation without tracheostomy, tracheostomy care without ventilation at home.

 

Our nurses manage exactly the kind of complex cases Frances is describing, post-cardiac event, heart failure, tracheostomy, PEG feeding, ongoing weaning, safely in the patient’s home, third-party accredited Intensive Care at Home nursing service because there is a number of things that set Intensive Care at Home apart, and both matter enormously when you are trusting a provider with a ventilated family member coming out of ICU.

 

Currently in 2026, we are the only third-party accredited Intensive Care at Home nursing service in Australia. We are accredited against International Organization for Standardization (ISO) 9001:2015, and we are NDIS registered. No other provider in Australia has achieved third-party accreditation for Intensive Care at Home nursing.

 

We are the only one, and we have been achieving this since 2012. We have built all the intellectual property policies and procedures from scratch, and you can find out more about our quality standards on our website at intensivecareathome.com/accreditationquality.

 

Furthermore, we are providing evidence-based services because our home ventilation model is built on Mechanical Home Ventilation Guidelines, not guesswork.

 

You can read the evidence-based mechanical home ventilation guidelines again on our website at intensivecareathome.com. Third-party accreditation is not just a paperwork exercise. It is the difference between a genuine critical care registered nurse model for Intensive Care at Home, managing your husband’s airway, ventilator, and weaning at home, and, for example, a general registered nurse or even worse, a support worker with minimal or no training doing the same job.

 

I have written and spoken many times about the case of Noah Johnston, a young man who died at home in December 2025 after his tracheostomy became displaced with no critical care registered nurse present.

 

That case is exactly why we insist on critical care registered nursing only staffing 24/7 with no exceptions and no downgrades to general registered nurses, let alone support workers.

 

For families like Frances, Intensive Care at Home means her husband can leave ICU with his tracheostomy and PEG in place, continue his weaning program and cardiac recovery, and be cared for at home by the same caliber of ICU nurse who is caring for him in ICU right now, not of a lesser standard and not a shift to comfort care by default.

 

If you are wondering, Frances, who is going to pay for it, I would not worry too much about it because an ICU bed costs $5,000 to $10,000 per bed day.

Intensive Care at Home is approximately 50% of that, so whoever is funding the ICU bed will have an interest in cutting that cost by 50%, and the ICU will also have an interest because we are helping them to free up one of their in-demand ICU beds.

 

It is a win-win situation all around. The bottom line, Frances, you are well within your rights to ask for a tracheostomy and PEG instead of accepting comfortable as the plan.

 

Once again, comfort care or making a patient comfortable is a euphemism for end-of-life care, which ends with the death of a patient, and that could be perceived as euthanasia, and euthanasia is illegal.

 

Frances, get the medical records, ask for the clinical reasoning in writing, get a second opinion if you need one, and do not let the ICU’s bed flow pressures decide your husband’s treatment plan for him.

 

If tracheostomy, PEG, and a genuine weaning attempt are on the table, the next question is, where does he do that weaning and recovery?

 

ICU is very rarely the best place for that.

 

Home with 24/7 critical care registered nurses with Intensive Care at Home usually is.

 

Go and contact me at intensivecareathome.com, call me on one of the numbers on the top of our website, or book a call with me on the website.

 

Click on the schedule appointment button, or send me an email to info@intensivecareathome.com.

 

Currently with Intensive Care at Home, we are operating all around Australia, in all states and territories, in all major capital cities, as well as in all regional and rural areas.

 

If you are watching this and you are in the United States, in the United Kingdom, in Canada, in India, please reach out to us as well.

 

We can help you internationally 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.