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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.  Tailor-made solutions for long-term ventilated adults and children on Bilevel Positive Airway Pressure (BiPAP), continuous positive airway pressure (CPAP) ventilation at home; tailor-made solutions for adults and children with tracheostomies without ventilation at home; tailor-made solutions for home ventilation and home tracheostomy weaning whenever medically appropriate; home cough assist management. Home total parenteral nutrition (TPN), home intravenous (IV) fluids, home IV antibiotics, home IV potassium, magnesium, and other electrolyte infusions, home central line, PICC line, Hickman’s line, port management at home, as well as nasogastric tube, nasojejunostomy tube, percutaneous endoscopic gastrostomy (PEG) tube management at home, indwelling urinary catheter (IDC), suprapubic catheter (SPC) management at home.  As well as palliative care management at home, we’re also providing Level 2 and Level 3 National Disability Insurance Scheme (NDIS) support coordination as well.

 

Today I have a question from a reader, Lorna, who says her 79-year-old father was admitted to a private hospital intensive care unit (ICU) with severe pneumonia.  He had a stroke 19 years ago that left him paralyzed on his left side and dependent on others for more care, although he could still eat, drink, and manage toileting on his own before his admission.  He’s now been on a mechanical ventilator for more than two weeks, with a tracheostomy for the last week.  His treating team has told the family there’s been no improvement in his lung function.  He also had a mild heart attack during the admission, which was treated.

 

Lorna and her family are worried that if he does recover, his quality of life could be worse than before, and they don’t know yet whether he has any hypoxic brain injury from the period before he reached ICU.  They want to know what questions to ask his doctors about his lung function, his prognosis, and his chance of recovery.  They also want to explore bringing their dad home with Intensive Care at Home nursing. Lorna and her family have told me they don’t believe life should be taken away by medical decisions or a lack of treatment or the refusal of such, and they want to keep their father alive.

 

I want to answer this very respectfully and practically, not by telling you what questions to ask, but by giving you the questions and the information you need to make an informed decision together with his treating team, and by explaining what a genuine Intensive Care at Home option looks like, if that’s the path you choose.

 

Before I answer the question in more detail, you might be wondering what makes me qualified to answer questions for families in intensive care that also lead to Intensive Care at Home.

 

I have been working 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 started Intensive Care at Home in 2012 here in Australia, and we’ve been operating ever since.  I also had pioneering experience in intensive care at home nursing in Germany in the early 2000s, where I was part of setting up intensive care at home in Germany. So, I have extensive experience in intensive care as well as Intensive Care at Home, including management experience.

 

So, let’s look at understanding the clinical picture and why no improvement in lung function matters.

 

When a patient has been ventilated for more than two weeks with no measurable improvement in lung function, it usually means one or more of the following is happening.  The underlying pneumonia hasn’t fully cleared, or a secondary infection, including ventilator-associated pneumonia, has developed.

There’s ongoing lung injury, sometimes described as acute respiratory distress syndrome (ARDS), also known as lung failure, where the lung tissue itself is inflamed and stiff, independent of the original infection.

 

Pre-existing reduced reserve: 19 years of left-sided paralysis and reduced mobility can mean weaker respiratory muscles and a less efficient cough, which makes clearing secretions harder.

The heart attack during this admission may be reducing the heart’s ability to support oxygen delivery, which can itself masquerade as or worsen poor lung function on the ventilator.

Possible hypoxic injury from before ICU admission, which the family has rightly flagged as unknown and needing formal assessment. None of this tells you the outcome. Only a full clinical workup can do that. But understanding the moving parts helps you ask sharper questions and stops you from accepting a vague “he’s not improving” without knowing why.

 

Here are the questions to ask the ICU doctor at your next family meeting, which I can be part of as well if you want me to. Based on what Lorna has described, here’s what I would be asking, organized into three areas she raised: lung function, quality of life and prognosis, and potential for recovery, including Intensive Care at Home.

 

Lung Function and the Ventilator

 

What are his current ventilator settings, fraction of inspired oxygen (FiO2), and positive end-expiratory pressure (PEEP), compared with two weeks ago?  Are they improving, static, or getting worse?  Has a spontaneous breathing trial (SBT) or tracheostomy weaning trial been attempted? If not, why not? And when will one be tried?  Is there a specific diagnosis for why the lungs aren’t improving? Unresolved pneumonia, ARDS, fluid overload, another infection?  What do the most recent chest X-ray, computed tomography (CT), and arterial blood gases results show, and what can we see?  Can we see the actual results, not just the summary?  Is his heart function from the recent heart attack being formally reassessed as a possible contributor to his breathing status?

 

Brain Function and Quality of Life

 

Has a formal neurological assessment been done to look for hypoxic brain injury, and if not, can one be arranged, including clinical examination and, where appropriate, imaging? What specific signs are you using to judge his level of consciousness and responsiveness, and how do these compare with his baseline before his illness? What would his realistic functional baseline look like if he stabilizes? Will he likely return close to his pre-admission level, mobile with assistance and self-feeding, or is more support likely to be needed? Who is coordinating his care across the ICU, cardiology, and any neurology input? Is there one point of contact for the family?

 

Recovery Potential and Next Steps

 

What would you consider a positive sign of improvement over the next 7 to 14 days?  What will concern you if he stabilizes on the ventilator with tracheostomy but doesn’t wean further?  What are our options, including a supported discharge home with Intensive Care at Home?

 

Can we get copies of his full medical records, including nursing notes, ventilator logs, specialist reviews, doctor’s notes, vital signs, laboratory results, fluid balance charts, ventilation charts, and other relevant records, so we can follow his progress in detail and get an independent second opinion if we want one?  You’re entitled to request your father’s medical records, and I’d strongly encourage you to do this in a case like this. Don’t rely only on verbal updates in a hurried family meeting.  Ask for the ventilator settings and trends, arterial blood gas results, chest imaging reports, magnetic resonance imaging (MRI) scans, CT scan reports, cardiology and any neurology notes, and the nursing observation charts.  Having the actual data lets you track whether no improvement is stable but slow, static, or declining, and it lets a second opinion, if you seek one, be a properly informed one rather than a guess.

 

And if you’re considering bringing him home, this is what Intensive Care at Home looks like. Lorna has asked about bringing her father home with Intensive Care at Home.  This is a very legitimate and proven option for patients who are stable enough to leave ICU but still need ventilation or tracheostomy care, which means they need 24-hour intensive care nursing.  Or they need close clinical monitoring, but it needs to be done properly with critical care registered nurses, not with a downgrade to general registered nurses, enrolled nurses, let alone disability support workers.

 

I’ve written detailed evidence-based Mechanical Home Ventilation Guidelines on exactly what’s safe, mechanical ventilation requirements, staffing ratios, equipment, emergency planning, and clinical governance, which you can read on our website, on our Mechanical Home Ventilation Guidelines, which are evidence-based.  I say this often, and I’ll say it again here.

A tracheostomy and a home ventilator are not something a general registered nurse, an enrolled nurse, or a disability support worker should be managing.  Think of it like a pilot in the cockpit. You wouldn’t want a co-pilot with a fraction of the training flying the airplane through turbulence.  The same logic applies to a paralyzed stroke patient with a fresh tracheostomy, a recent heart attack, and unresolved lung function issues.

 

This is ICU nursing level care, 24/7, not general registered nurses, not enrolled nurses, and definitely not disability support workers.  This is exactly why Intensive Care at Home is the only intensive care at home nursing service in Australia that is third-party accredited specifically for intensive care at home nursing through ISO 9001:2015, and also NDIS registered and accredited.  You can verify our accreditation status on our website at intensivecareathome.com (http://intensivecareathome.com)/accreditation-quality).

 

Let’s now move to some real cases that show why the right level of care matters, and let’s start with a cautionary tale, Noah Johnston.  I’m very insistent on 24/7 critical care registered nurse (CCRN)-led care rather than general registered nurses, enrolled nurses, or disability support workers managing a tracheostomy on a ventilator.  In December 2025, a young man named Noah Johnson died after his tracheostomy tube became displaced while no critical care registered nurse was present. It’s a case I refer to very often, and one his family’s lawyer has also raised with me since, because it illustrates in the starkest possible terms what’s at stake when tracheostomy and ventilator care is downgraded to a level of staffing that isn’t equipped to manage an airway emergency in the first minute it happens.  This is precisely the risk your family needs to rule out if you’re looking at home care options for your dad.

 

And let’s look at proof of sustained quality of life.  One of our clients, Ian Haywood, has also been in the public arena.

I understand the fear that if your dad doesn’t recover, there may not be any quality of life, but I want to give you a real case example rather than just reassurance.  One of our clients has been an Intensive Care at Home client since 2019 and is the longest-living motor neurone disease client we’ve supported in Australia, fully ventilator-dependent, living at home with 24/7 critical care registered nurses.

 

In 2021, the NDIS (National Disability Insurance Scheme) attempted to cut his nursing funding from 24 hours a day down to just six hours, a decision that would have made safe home care impossible, and that funding was successfully defended at the Administrative Appeals Tribunal (AAT).  Ian’s case shows that with the right nursing in place, a genuinely high quality of life at home is possible even with total ventilator dependency for years, not just weeks or months. I also want to refer here to Stephen Hawking, who lived in the United Kingdom with motor neurone disease, ventilated and with a tracheostomy for decades.

 

So, here’s what I recommend for your family right now, Lorna.

 

Request access to all medical records and specific data outlined above before your next family meeting with the intensive care team, and I can participate in that family meeting as well.  Ask directly for a formal neurological assessment for possible hypoxic injury, if one hasn’t already been done.  Ask what a realistic pathway home will look like if he stabilizes on the ventilator with tracheostomy but doesn’t fully wean.

 

And ask specifically about CCRN-led home ICU as an option with Intensive Care at Home, not just standard community nursing or a residential aged care placement, because they won’t take him anyway.

 

And if you want an independent, experienced ICU nurse’s perspective on what you’re being told, including help interpreting ventilation settings, arterial blood gases, and preparing for family meetings, that’s exactly what we do here as well with consulting and advocacy.

 

And if your father does stabilize and your family decides home is the right setting, Intensive Care at Home provides 24/7 ICU nursing-led care for invasive ventilation with tracheostomy, non-invasive ventilation, BiPAP, CPAP, and tracheostomy care without ventilation, IV fluids, IV antibiotics, IV TPN, whatever you need, for exactly the kind of complex, high-acuity situation.

 

Lorna has described our teams operating all around Australia, in all states and territories, with many funding bodies attached to it.

Bringing a ventilator- and tracheostomy-dependent parent home after a complicated ICU stay is a big decision, and it should never mean compromising on the level of nursing skill in the room.

 

That’s the whole reason Intensive Care at Home exists, and it’s why we sought third-party accreditation specifically for this type of care, so families have an independently verified standard to rely on rather than just our word for it.

 

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 a 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 a 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 and 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 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 is applicable to 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, how to advocate for it, or 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 availability 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 at 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.