INTENSIVE CARE AT HOME™ is a specialised niche Intensive Home Care Nursing service provider, providing Quality of Life and/or Quality of-end-of Life for long- term mechanically ventilated Adults& Children with Tracheostomy and their Families.
The service was founded in late 2011, by the Director Patrik Hutzel who has more than 15 years international Critical Care Nursing Experience in Germany, the United Kingdom and Australia.
The basics of INTENSIVE CARE AT HOME™’s service Philosophy can be found in observations, experiences, pain points, frustrations and issues around Quality of Life and/or Quality of-end-of-life for Patients, their Families and staff alike within different Intensive Care environments. The issues around Quality of Life and/or Quality of-end-of-Life in Intensive Care for Patients and for Families- more often than not- come with massive ethical and moral questions and dilemmas in a highly charged clinical environment.
Grounded in those experiences, INTENSIVE CARE AT HOMETM has found that in a high stress and high pressure environment like Intensive Care, issues like Quality of life, Quality of-end-of-life, the discussions and the decision making process around Quality of Life and/or Quality-of-end-of Life issues, is very often limited to the resources available and to the current clinical paradigm prevalent in an Intensive Care environment, which is very often based on a scarcity mindset. There is very often little discussion and/or involvement of the Patient and the Families of what might be in the best interest for a long-term ICU Patient on a ventilator with Tracheostomy and their families, leaving Patients and their Families extremely vulnerable, without an option and without peace of mind .
Sometimes Intensive Care staffs perception are that they know what is best for the long- term ICU Patient and/or their family. Intensive Care staff also very often base their decisions within a very strict and scarce clinical mindset or paradigm, without considering alternative options. This very often leads to a one sided decision making process, where Intensive Care staff compare poor Quality of Life or poor prognosis in Intensive Care, to poor general Quality of life, without taking other opportunities or possibilities into account- which admittedly in Australia so far- has also been due to a lack of alternative service providers.
NFR(Not for Resuscitation) orders, Treatment limitations or palliative treatments may be ordered across a wide range of Patients of all ages in Intensive Care, sometimes violating hospital policies and without proper Patient or Family consent, involvement and education for Patients and their families. This very often leads to massive ethical and moral dilemmas, due to lack of education, lack of understanding and lack of knowledge of what may be possible, as well as what has been available for long-term mechanically ventilated Adults& Children with Tracheostomy and their families, as a proven and reliable alternative in European countries for more than a decade.
It also leaves a number of Patients in Intensive Care, their families and staff in Intensive Care very vulnerable, sometimes utterly despaired, with no peace of mind- and I guess everybody who has either worked in ICU or who has lost a loved one in ICU knows how heart breaking this experience can be. But even if Patients do survive the acute phase in Intensive Care- poor prognosis, poor health, poor support mechanisms, time constraints, scarce resources, as well as current clinical paradigms lead to no perceived alternatives and options for long- term mechanically ventilated Adults& Children with Tracheostomy and their Families, but to either
- stay in Intensive Care for very long period of times, with depression, very little dignity, very little privacy and no or very little Quality of Life and/or Quality of-end-of-Life
- stay in Intensive Care for very long periods of time, with a very high likelihood of catching a hospital acquired infection with the likelihood of an even longer stay in Intensive Care or even death, whilst also using scarce resources that could be used for more acute Patients
- face treatment limitations due to a lack of specialised alternative service providers and very often end up dying in Intensive Care
- end up on in a hospital ward bed with a treatment limitation order and no return to ICU
- end up in low level care facilities with no specialist support and no specialist care
- end up at home with no specialist support and no specialist care
But there is light at the end of the tunnel. Since the late 1990’s successful models have been developed in mainly European countries such as Germany, Austria and Switzerland, but also in parts of the US. In Germany for example, a number of privately led organisations exist- who currently cover most big metropolitan areas in Germany, with specialist Intensive Home Care Nursing services for long-term mechanically ventilated Adults& Children and their Families.
Patrik was fortunate and has gained some “hands- on experience” in one of the organisations for a number of years, before venturing overseas, to continue his ICU nursing career in the United Kingdom and Australia.
What Patrik has learned in the community setting, whilst providing specialist Intensive Home Care nursing services to a wide range of Customers, starting from ventilated children to ventilated adults has been a good starting point to eventually start a similar service in Australia.