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My name is Patrik Hutzel from Intensive Care at Home at intensivecareathome.com, and today I have a question from Robert who says:

 

“Hi Patrik, 

I am trying to understand the plan for my dad and knowing when he opens his eyes and is scared and confused. He is still on the ventilator with tracheostomy in ICU, but he has also had some time off the ventilator. What is ICU care at home like? Can you explain more about ICU at home? Because I wish to take my dad home and receive the same ICU care at our home.

 

From Robert.”

 

At intensivecareathome.com, 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) at home — non-invasive ventilation — where we provide tailor-made solutions for adults and children with tracheostomy without ventilation, home cough assist management, home ventilation and tracheostomy weaning whenever medically appropriate, home TPN (Total Parenteral Nutrition), home IV fluids, home IV antibiotics, home IV potassium, magnesium and other electrolyte infusions, home central line, PICC (Peripherally Inserted Central Catheter) line, Hickman’s line, and port management at home. We also provide nasogastric and nasojejunostomy tube, PEG (Percutaneous Endoscopic Gastrostomy) and PEJ (Percutaneous Endoscopic Jejunostomy) tube management at home, SPC (Suprapubic Catheter) and IDC (Indwelling Catheter) management at home, as well as palliative care management at home. We are also providing Level 2 and Level 3 NDIS (National Disability Insurance Scheme) support coordination as well as TAC (Transport Accident Commission) and WorkSafe case management.

 

Thank you, Robert, for reaching out. What you are describing — your dad opening his eyes and being scared, confused, and disoriented while still connected to a ventilator with tracheostomy, but also having some periods off the ventilator — is one of the most common and most misunderstood phases of a long ICU journey.

 

Let me break down what is actually happening, why it happens, what can be done about it, and how you can bring your dad home safely to receive the same standard of ICU care at home.

 

Before I break down what is actually happening in ICU with Robert’s dad when he wakes up scared and confused, you might be wondering what makes me qualified to answer questions for families in intensive care and for 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 in Germany in the early 2000s with a company called Brambring and Jaschke, and I brought the concept to Australia successfully in 2012. That is how long we have been operating in Australia. We are the only third-party Intensive Care at Home nursing service that is accredited as well as NDIS registered.

 

What Is Actually Happening When Your Dad Wakes Up Scared and Confused

When someone has been critically ill, sedated, and ventilated for an extended period, the process of waking up is rarely a single, clean moment. It is a gradual, often frightening transition.

 

Your dad having a tracheostomy tells me he has likely been ventilated for a while already — long enough that the medical team moved him from an ETT (Endotracheal Tube) to a tracheostomy tube to reduce sedation needs and start the ventilation weaning process. The fact he is now having time off the ventilator is genuinely a positive sign, meaning his respiratory drive and lung function are recovering enough to trial breathing with less or no machine support.

But waking up scared and confused while all of this is happening is extremely common, and it has a name also known as ICU delirium or ICU psychosis.. It is not the same as dementia and it does not necessarily mean lasting brain damage, but it is obviously very distressing for him and for you to watch. And it needs to be actively managed, not just waited out.

 

Why This Happens: The Real Causes Behind the Confusion

Number one: ICU delirium, caused by a combination of the critical illness itself, sedative and opiate medications, sleep deprivation from 24/7 lighting, noise and interventions, and the sheer disorientation of not knowing where he is or how much time has passed.

 

Number two: Sedation withdrawal. As sedative infusions like propofol, midazolam, dexmedetomidine (also known as Precedex), fentanyl, and morphine are weaned down — which they have to be to allow ventilator weaning — the brain can go through a withdrawal-like phase with agitation, confusion, and fear.

 

Number three: Loss of day and night rhythm, also known as ICU psychosis or sundowning syndrome. Without normal cues like daylight, familiar faces, and a normal sleep pattern, the brain’s sense of time and safety breaks down.

Number four: Fear and lack of communication. With a tracheostomy in place, your dad cannot speak normally, which means he may be fully aware and terrified but unable to tell anyone what is wrong — which massively worsens agitation and fear.

 

Number five: Underlying medical causes such as infection, low oxygen levels, electrolyte imbalances, or pain can all present as confusion and agitation. Any new confusion should always trigger a medical review, not just be attributed to ICU delirium by default.

 

Treatment Options: What Should Be Happening for Your Dad Right Now

Number one: Active delirium screening and management. The ICU team should be using a validated delirium assessment tool regularly — not just noting “patient confused” in passing.

 

Number two: Sedation minimization — using the lightest effective sedation with regular sedation breaks, rather than keeping him deeply sedated by default.

Number three: A structured tracheostomy and ventilator weaning plan, gradually increasing time off the ventilator with clear criteria for progress — not an ad hoc approach.

 

Number four: A communication plan — a speaking valve trial if he is medically ready, or a communication board and alphabet chart in the meantime, so he can express fear, pain, or needs instead of just enduring them silently.

Number five: Family presence and orientation. You being there, talking to him, telling him the date, where he is, and what is happening is genuinely therapeutic and evidence-based for reducing delirium.

 

Number six: Early mobilization. Getting him sitting up and moving out of bed where safely possible reduces delirium and psychosis, increases his strength, and speeds up recovery.

 

Advocacy for Your Dad: Your Right to the Medical Records and the Plan

Robert, you used the word “plan” in your email — and that is exactly the right instinct. You are entitled to ask the right questions of the treating team directly:

• What is the ventilation weaning plan?
• What is the tracheostomy weaning plan?
• What is being done about his delirium and agitation?
• What does home realistically look like for him?

Do not accept vague answers. Ask for the plan in writing if you need to. You are also entitled to request access to his medical records. This is not being difficult — this is being an informed advocate for your father at a time when he cannot advocate for himself.

If you are not getting clear answers from the bedside team, ask to speak to the treating intensivist directly. And do not be afraid to ask for a second opinion if something does not sit right with you.

 

What Intensive Care at Home Actually Looks Like

Robert, this is exactly what you are asking me — but I also believe I needed to lay the groundwork first so that you understand what is happening in intensive care and can now understand what the options are for intensive care at home and how that will improve your dad’s situation and your situation too as a family.

Can your dad really come home with a tracheostomy, on and off the ventilator, and still be safe? The simple answer is yes. This is precisely what Intensive Care at Home was built for. We provide 24/7 critical care registered nurses in the family home for adults and children who are invasively ventilated with tracheostomy, or on non-invasive ventilation such as BiPAP or CPAP, or who have a tracheostomy without needing ventilation at all.

 

Your dad would not be handed over to a support worker or a general community or general registered nurse. He would be cared for by the same calibre of critical care registered nurse who would be looking after him in an ICU or HDU (High Dependency Unit) — in his own home, in his own bed, surrounded by family instead of strangers and monitors beeping through the night.

 

Everything we do is built on evidence-based practice, not guesswork. I would strongly encourage you to read through our evidence-based Mechanical Home Ventilation Guidelines, which set out exactly how we manage ventilation weaning, tracheostomy care, emergency preparedness, and clinical governance at home. I will put a link to the evidence-based Mechanical Home Ventilation Guidelines in the show notes and the transcript of this video.

 

This is genuinely important for you to know as you are doing your research. Intensive Care at Home is the only intensive care at home nursing service in Australia in 2026 that is third-party accredited specifically for Intensive Care at Home nursing under ISO 9001:2015, as well as NDIS registered for Intensive Care at Home. Anyone can put “ICU at home” on a website. Third-party accreditation and NDIS registration is actually proof that our clinical governance, our nursing standards, and our safety systems have been independently checked and verified — not just self-declared. You can see the details on our website at intensivecareathome.com/accreditation-quality.

 

With Intensive Care at Home, we are currently operating all around Australia in all states and territories, in all metropolitan, regional, and rural areas. We employ hundreds of years of critical care nursing experience combined in our team, and that means we can bring the highest skill levels into the community. We also provide Level 2 and Level 3 NDIS support coordination as well as TAC and WorkSafe case management. So if funding is uncertain right now — whether it is through departments of health, private health funds, NDIS, hospital-funded transitional care, aged care, DVA (Department of Veterans’ Affairs), or private health funds — we can help you work out what your dad may be eligible for and how to build the case for it. If we could not do that, we would not exist, Robert. And once the funding is there, we will organize equipment and create a tailor-made team for you of people you can know, like, and trust to look after your dad at home.

 

The Bottom Line

Robert, your dad opening his eyes and being scared and confused is not a sign that things are going wrong. It is very often a sign his body is starting to wake up from weeks of critical illness, sedation, and everything ICU does to keep someone alive. But it is a sign that he and you, need people around him who know how to manage that very transition safely, both in ICU and afterwards with Intensive Care at Home.

 

Bringing him home with Intensive Care at Home with 24/7 critical care registered nursing support means he is finally getting that safety without staying in ICU indefinitely. And you get your dad back in his own home and you will get your life back.

 

If you would like to talk through your specific situation, call us on our website at www.intensivecareathome.com, or book a call with me by clicking on the Schedule Appointment button, or you can call me directly on my mobile phone if you are in Australia on 0410 942 230 — that is again 0410 942 230. You can also send me an email to [email protected].

 

If you are in the US (United States), in the UK (United Kingdom), in Canada, in India, or wherever you are and you are interested in Intensive Care at Home, I also encourage you to reach out because 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.