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My name is Patrik Hutzel from Intensive Care at Home. We provide tailor-made solutions for long-term ventilated adults and children at home with tracheostomy with 24-hour critical care registered nurses (CCRNs). We provide tailor-made solutions for long-term ventilated adults and children on BiPAP (Bilevel Positive Airway Pressure) and CPAP (Continuous Positive Airway Pressure) with 24-hour critical care registered nurses. We also provide tailor-made solutions for adults with tracheostomy without ventilation at home with 24-hour critical care registered nurses. We provide ventilation weaning and tracheostomy weaning when medically appropriate. We provide cough assist management at home, home TPN (total parenteral nutrition), home IV (intravenous) fluids, home IV antibiotics, home IV potassium, home IV magnesium, and other electrolyte infusions at home. This goes hand in hand with central line, PICC (peripherally inserted central catheter) line, Hickman line, and port management at home.  We are providing home IDC (indwelling catheter) and SPC (suprapubic catheter) management, PEG (Percutaneous Endoscopic Gastrostomy) tube management, nasogastric tube management, and nasojejunostomy tube management at home, as well as palliative care management at home. We provide Level 2 and Level 3 NDIS (National Disability Insurance Scheme) support coordination, as well as TAC (Transport Accident Commission) and WorkSafe case management.

 

In today’s article and video, I want to clear up something I keep hearing from families, referrers, hospital discharge planners, NDIS support coordinators, case managers, and sometimes even from NDIS planners and other funding bodies. Who is actually providing medical governance and medical oversight when a client is receiving ICU (intensive care unit) level care at home? There seems to be a little bit of confusion out there about this.

 

Some stakeholders assume that once a ventilated client, a tracheostomy client, or a client on BiPAP or CPAP leaves the hospital and ICU and comes home, medical oversight somehow stops. It clearly doesn’t. It never has, and it never will for any client we support at intensivecareathome.com. Let me explain exactly how it works.

 

What Is Medical Governance, and Why Does the Confusion Exist?

Let’s start with what medical governance is and why the confusion exists. Medical governance means that a qualified medical practitioner is responsible for the diagnosis, the treatment, the plan, the medical orders, and the ongoing medical decision-making for a client’s condition. That practitioner is not a nurse, not even an ICU nurse, not a general registered nurse, not an enrolled nurse, not a support worker, and not a case manager. Nursing governance and clinical care delivery sit alongside medical governance, but they are not a substitute for it. They need to go hand in hand.

 

The confusion happens because in a hospital ICU, a doctor is physically present, or at least on the floor, 24/7. At home, that changes. There is no doctor standing at the bedside around the clock, unlike our nurses. Some people wrongly read that as no medical governance. That’s simply not correct, and it’s not how any properly run home intensive care, home ventilation, or complex care nursing service operates, including ours.

 

Who Provides Medical Governance at Intensive Care at Home

Medical governance at Intensive Care at Home is always in place. Every single client we support has medical governance in place. Who that governance comes from depends entirely on the client’s condition and diagnosis. Sometimes it also depends on the state or the city they live in, and on where they are in their treatment journey. In practice, it can be:

• ICU consultants and intensive care specialists, who sometimes sit attached to the hospital that discharged the client and sometimes are engaged privately. We work with ICU consultants privately.
• Respiratory physicians, for clients on long-term ventilation, BiPAP, or CPAP.
• General practitioners (GPs), who very often become the primary treating medical practitioner once a client is medically stable at home.
• Paediatricians, for the children and young people we support with tracheostomies and home ventilation.
• Anaesthetists, particularly for complex airway management cases.
• Neurologists, for clients with motor neuron disease, amyotrophic lateral sclerosis (ALS), spinal cord injury, Rett syndrome, cerebral palsy, and other progressive neuromuscular conditions, which also include muscular dystrophy.

 

In essence, there is no scenario in which one of our clients is receiving tracheostomy care, invasive ventilation, non-invasive ventilation, or complex nursing care without a named, responsible treating medical practitioner behind that care. We can’t do anything as nurses without medical oversight or against medical advice.

 

In the state of Victoria, pretty much all our adult clients have medical oversight from the VRSS, the Victorian Respiratory Support Service, out of the Austin Hospital. They are pretty much overseeing medically all ventilated and most tracheostomy clients at home in the community in the state of Victoria.

 

How Medical Governance Works in Practice

Here is the mechanism, because this is the part that’s usually missing from the conversation. The treating medical practitioner sets the medical orders, the ventilation or airway management plan, medication authorities, and the escalation parameters. Those triggers tell our 24/7 critical care registered nurses exactly when to escalate and to whom. Our CCRNs then deliver care under that medical direction, monitor the client continuously 24 hours a day, document everything, and escalate the moment something falls outside the parameters that have been set.

 

I often and frequently use the analogy of a pilot in the cockpit. Our CCRN is the pilot: trained, present, hands-on, and accountable in the moment, exactly as a hospital ICU nurse would be. But a pilot doesn’t invent the flight plan. The route, the go or no-go calls, and the clinical direction come from the treating medical team, whether that’s an ICU consultant, a respiratory physician, a GP (general practitioner), a paediatrician, an anaesthetist, or a neurologist.

 

That is medical governance, and it is present in every single case we manage. It doesn’t matter whether the client is a ventilated adult in any state, a child with a tracheostomy in Queensland, or an MND (Motor Neuron Disease) client in South Australia. The hospitals are slightly interchangeable depending on the governance structure in different states, but there’s always medical oversight, and sometimes it comes from the hospital directly, whether for adults or paediatrics.

 

This is exactly why our care model is built around our own published, evidence-based Mechanical Home Ventilation Guidelines, which you can read on our website at intensivecareathome.com. Medical governance, delegation, and escalation aren’t left to guesswork on either side.

 

Why Accurate Documentation Is Central to Medical Governance

Medical governance only works if it’s visible and auditable, not just assumed. That means care plans, medical certifications, standing orders, PRN (as-needed) orders, medication charts, and progress notes.   All need to be accurate, current, and accessible to everyone involved: the treating doctor, our CCRNs, the family, and where relevant, the funding body or case manager.

This is part of the medical records advocacy work we do as a matter of course when documentation is incomplete, outdated, or inconsistent with what’s happening at the bedside. That’s when confusion about who’s in charge medically creeps in, and it’s also when safety incidents become more likely. Keeping the paper trail tight isn’t red tape. It’s what makes medical governance real and defensible rather than theoretical.

 

Need Help Understanding the Medical Governance in Your Own Situation?

If you’re a family member, a case manager, a patient, or a support coordinator with the NDIS (National Disability Insurance Scheme), and you’re not sure who’s providing medical governance for your own or your client’s home ventilation, tracheostomy, or complex care needs, including TPN, we offer direct one-on-one advice so you can get clarity before something goes wrong, and not after.

 

Call me on one of the numbers at the top of our website at intensivecareathome.com. You can call the 1300 number, or you can call me directly on my mobile phone, 0410 942 230. That’s again 0410 942 230. You can also schedule an appointment with me by clicking the schedule call button on the website at intensivecareathome.com, or you can email me at [email protected].

 

If you’re watching this in the US, the UK, Canada, or India and you want to know about intensive care at home, please reach out to us as well.

 

Third-Party Accreditation

 

Our third-party accreditation is proof that our governance and care model holds up to standards. Talk is cheap in this industry. That’s why Intensive Care at Home, in 2026, is the only intensive care at home nursing service in Australia that is a third-party accredited Intensive Care at Home nursing service as well as NDIS registered. We are accredited against ISO (International Organization for Standardization) 9001:2015 as well as NDIS registered. This is not self-declared.

 

Our entire model, including the medical governance, delegation, and escalation work, is also underpinned by our own published, evidence-based Mechanical Home Ventilation Guidelines, which you can find on our website. If you want to see the standards, we hold ourselves to before you commit to any home ventilation or complex care nursing provider, both pages are worth reading in full and are linked in the show notes.

 

We support long-term ventilated adults and children with tracheostomies, adults and children on BiPAP and CPAP, and adults and children with tracheostomy without ventilation, including cough assist management and so forth. We operate all around Australia, in all major capital cities as well as in all regional and remote areas, in all states and territories. We employ hundreds of years of critical care nursing experience combined, enabling us to look after high-acuity clients safely in the community so that they can live at home permanently and predictably. We also provide Level 2 and Level 3 NDIS support coordination as well as TAC and WorkSafe case management.

 

The bottom line is that medical governance never disappears just because the ICU bed has become a bedroom. It’s always there. It just looks different at home than it does in ICU. It is delivered through the treating specialist or GP who sets the plan and is executed and monitored by our CCRNs under that direction. If anyone tells you otherwise, or if you’re not sure who’s providing it for your own situation, pick up the phone and ask. That’s what we’re here for. You can call us right now.

 

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.

 

This is Patrik Hutzel from intensivecareathome.com, and I’ll talk to you in a few days.

 

Take care for now.