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 with 24-hour critical care and ICU nurses, where we provide tailor-made solutions for long-term ventilated adults and children on BiPAP (Bilevel Positive Airway Pressure) without tracheostomy, non-invasive ventilation, with 24-hour critical care registered nurses, where we provide tailor-made solutions for clients with tracheostomy without ventilation with 24-hour ICU nurses at home, critical care registered nurses at home.

We provide home ventilation and home tracheostomy weaning when medically appropriate. We provide home cough assist management, home TPN (Total Parenteral Nutrition), home IV (intravenous) fluids, home IV antibiotics, home IV potassium and magnesium infusions. We provide central line, PICC (Peripherally Inserted Central Catheter) line, Hickman’s line and port management at home, IDC (Indwelling Catheter), SPC (Suprapubic Catheter), PEG (Percutaneous Endoscopic Gastrostomy) and PEJ (Percutaneous Endoscopic Jejunostomy) tube, as well as nasogastric tube and nasojejunostomy tube management at home. We provide palliative care management at home, as well as Level 2 and Level 3 NDIS (National Disability Insurance Scheme) support coordination, as well as TAC (Transport Accident Commission) case management.

Now, in today’s blog, I have a question from a reader who says:

“Hi Patrik,

My mother has had a brain tumor for 8 years, and now suddenly she cannot breathe. So, we took her to hospital, and there she’s on BiPAP in ICU. But the doctors say she won’t survive, and we also want to end her suffering and want her to be free from suffering. The doctor suggested to stop the BiPAP, that it would slowly end her life without any pain by CO2 (carbon dioxide) narcosis. So can you please tell me, can we take her home with Intensive Care at Home, and can we go for her death at home?”

Now, first of all, I’m very sorry you’re going through this. Watching your mom struggle to breathe after 8 years of living with a brain tumor is heartbreaking. The fact that you are asking this very question tells me how much you love her and how much you want her last days to be peaceful and dignified.

The short answer is, in most cases, yes. It is possible to bring someone home from ICU on BiPAP so they can pass away at home, surrounded by family, with comfort care in place. But like with anything, it needs careful planning, the agreement of the treating team, and the right doctors and nurses involved, with 24-hour critical care registered nurses at home.

Before I walk you through it, you might be wondering what makes me qualified to answer questions like this. 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 5 years in intensive care, and I started Intensive Care at Home here in Australia in 2012. That’s how long we’ve been operating. I was also part of a pioneering Intensive Care at Home service in Germany in the early 2000s, where we were the first ones providing Intensive Care at Home, and that was with Brambring Jaschke in Munich. Big shout out here to Jörg and Kristoff. And I brought the concept to Australia in 2012, and that’s how long we’ve been operating here in Australia, and we’ve delivered millions of hours of Intensive Care at Home nursing safely.

So also, if you need help planning end-of-life care at home today, because time matters in situations like this, you can call Intensive Care at Home right now at intensivecareathome.com, on one of the numbers on the top of our website. Right now, we operate all around Australia, in all states and territories. You can call us on one of the numbers on the top of our website. You can call me on my mobile phone, 041 094 2230. You can book a call with me by clicking on the schedule appointment button on our website, or you can send me an email to [email protected]. And if you’re overseas in other countries, I’ll come to that. You can contact us as well.

Let’s get on with the question for now. What is happening when someone with a brain tumor suddenly can’t breathe? When a person has lived with a brain tumor for many years, a sudden breathing crisis is often a sign that the disease has progressed. There are several ways this can happen, and your mom’s treating team is best placed to explain which applies to her.

Number one, the tumor affects the brain stem or the breathing center. The brain stem controls breathing automatically. Pressure or growth in that area can weaken the drive to breathe.

Number two, raised pressure inside the skull can reduce consciousness, and a person who’s very drowsy may not breathe deeply enough or protect their airway.

Number three, swallowing problems and aspiration pneumonia. Saliva or food going into the lungs can cause pneumonia, which is a common reason for respiratory failure in people with advanced neurological disease.

Number four, seizures, weakness and immobility can all add to the problem.

The result is usually what we call hypercapnic respiratory failure. The body can’t breathe out enough carbon dioxide, CO2, so CO2 builds up in the blood. That’s exactly what BiPAP is designed to support. But here’s the important point: BiPAP supports breathing. It does not treat a brain tumor. When doctors say someone won’t survive, they usually mean the underlying disease has reached a point where BiPAP is only prolonging the dying process rather than giving the person back quality of life.

Next, what does CO2 narcosis mean, and is stopping BiPAP painless? When BiPAP is removed from someone who can no longer breathe adequately on their own, CO2 levels, or carbon dioxide levels, rise. Rising CO2 causes increasing drowsiness, then unconsciousness. That’s what doctors mean by CO2 narcosis. Many people do drift off peacefully this way. But I want to be clear with you, because honesty is what families deserve: comfort is not automatic. Comfort is planned. Some people can experience breathlessness, air hunger, agitation or noisy breathing, particularly in the first period after the mask comes off.

That’s why best practice and evidence-based practice is clear. Our evidence-based Mechanical Home Ventilation Guidelines state that when ventilation is withheld or withdrawn, the principles of palliative medicine must be applied, using pre-emptive medication and non-medication measures for breathlessness, agitation and pain, and that the person should be given a private, dignified space with their family and loved ones around them, and that is a home care environment. In practice, that means a doctor prescribes comfort medications in advance, and experienced nurses give them and watch closely for any sign of distress before, during and after the BiPAP is removed. The specific medications and doses are always a decision for the treating doctor.

Is stopping BiPAP the same as euthanasia or voluntary assisted dying? No. This is a question many families quietly worry about, so let’s be clear. Withdrawing a life-sustaining treatment like BiPAP, when it is no longer helping and is only prolonging dying, is an accepted part of medical and palliative care in Australia, in the US, in the UK, in most countries. The person dies from their underlying illness, and the intention of the care is comfort, not to end life. Voluntary assisted dying is a completely separate legal process with its own strict eligibility rules and procedures, and it’s not what we’re talking about here. Intensive Care at Home does not provide voluntary assisted dying. And if you have any doubt, ask your mom’s ICU consultant or palliative care team to explain the difference. A good team will be happy to talk you through it.

Next, who makes the decision to stop BiPAP? Ideally, your mom herself, if she’s able to express her wishes. If she can’t, the decision is made with the person she appointed, or who the law in your area recognizes as a medical treatment decision maker or substitute decision maker, together with the treating doctors. If she has an advance care directive, or has talked about what she would want at the end of her life, that’s incredibly important. Our guidelines note that a refusal of treatment in a valid advance care directive is binding when the situation matches what the person described.

Ask for a family meeting with the ICU consultant and, if possible, the palliative care team, so everyone hears the same information and message at the same time.

So what are the options for end-of-life care when someone is on BiPAP in ICU, including Intensive Care at Home? Broadly, families usually have the following options.

Number one, stay in ICU with a comfort focus. BiPAP is either continued for comfort or removed in ICU, with palliative medications and the family present.

Number two, move to a palliative care ward or hospice, where a bed is available and the person is stable enough to transfer.

And number three, come home on BiPAP with 24/7 critical care registered nurses and a palliative care plan. BiPAP continues during the transfer and at home until the family is ready, and is then removed at home under a doctor’s plan, with comfort care in place.

There’s no right or wrong choice for every family. For some, a quiet room in ICU is right. For some, a quiet room on a palliative care or hospice ward in a hospital is right. For others, being in their own bed in their own home, with a garden outside the window, the family around them, the pets around them, means everything. That’s the choice we help families make possible with Intensive Care at Home.

So that leads to the next question: can you take someone home from ICU on BiPAP to die at home peacefully? In many cases, yes. We have done it many times. Our team has supported families to bring loved ones home from ICU on BiPAP for palliative care, and you can read one of our published examples in the link in the show notes, where I linked to a case study where we have done palliative care at home for a client on BiPAP instead of ICU.

To do it safely, a few things need to be in place, usually within days and sometimes within hours.

Number one, agreement from the ICU treating team and a clear written end-of-life and palliative care plan, including not for resuscitation documentation, which is appropriate in a situation like that.

Number two, medical governance and a doctor in the community, usually a palliative care specialist and/or GP (General Practitioner). It can also be an intensive care specialist. We can help you with the setup there. The doctor will prescribe comfort medications, guide the withdrawal of BiPAP at home, and be available for advice. We work with our own intensive care specialist.

Number three, safe transfer: an ambulance able to transport someone on BiPAP. Families need to know there is a risk their loved one may deteriorate during the transfer, and the treating team should discuss that with you openly.

Number four, equipment at home: the BiPAP machine with battery backup, the right masks, oxygen if prescribed, suction, monitoring, a suitable bed, a portable hoist, etc.

Number five, 24/7 critical care registered nurses at the bedside. Someone on BiPAP who’s close to the end of life can change minute by minute. Our team is exclusively ICU-trained, and our guidelines set a minimum of 18 months ICU experience, but most of our nurses have a minimum of two years. As a matter of fact, the average nurse that’s employed by us probably has closer to 8 to 10 years ICU experience. As a matter of fact, we employ hundreds of years of intensive care nursing experience combined in the community. That brings the highest skill level into the community in Australia. And we have designated senior critical care nurses coordinating care.

Number six, a plan for after life has ceased: a plan for when death occurs, who to call, how death will be verified, and when to contact your funeral director, so the family isn’t left uncertain or calling an ambulance in a moment that should be calm and peaceful.

Think of it like a pilot in the cockpit. When conditions can change in seconds, you want someone with years of training at the controls, not someone learning on the job when the stakes are high. That’s the role 24/7 critical care registered nurses play at the bedside, and play with Intensive Care at Home.

So, what should you ask the ICU team right now? Medical records and clear documentation are your friend. Ask for:

Number one, a family meeting to discuss prognosis, goals of care and the Intensive Care at Home option.

Number two, the end-of-life or goals of care plan in writing, including resuscitation status, and these should all be driven by you or by your family member.

Number three, a palliative care referral in hospital as well as in the community.

Number four, copies of relevant medical records, including the discharge summary and medication chart, so the community team has the full picture.

Number five, the ICU team’s view on whether a transfer home is realistic and how quickly it needs to happen.

So why should you choose Intensive Care at Home for end-of-life care on BiPAP? Intensive Care at Home, to my knowledge, in 2026 is Australia’s only third-party accredited Intensive Care at Home nursing service, accredited specifically for Intensive Care at Home nursing. Our quality management system is certified to ISO (International Organization for Standardization) 9001:2015 for the delivery of intensive care nursing services at home, and that includes NDIS registration, and it includes looking after mechanically ventilated patients at home, with tracheostomy and without tracheostomy, which includes BiPAP, and tracheostomy without ventilation. And you can view our accreditation and NDIS registration status on our accreditation and quality page on our website. I’ll link to it in the show notes.

So what does that all mean for you and your family? Only 24/7 ICU critical care registered nurses, in line with our evidence-based mechanical home ventilation guidelines. 24/7 nursing working alongside your loved one’s palliative care doctor and GP, or with our ICU consultant. Help with discharge planning, liaising with the ICU team, equipment providers and the community palliative care services. Care for the whole family holistically, not just the patient, during one of the hardest times of your life.

Currently, with Intensive Care at Home, we operate all around Australia, in all states and territories, and funding options depend on each person’s circumstances, and we’ll talk you through them on the phone. We have a lot of experience. Always keep in mind that an ICU bed costs $5,000 to $10,000 a day, to our knowledge, and Intensive Care at Home approximately costs 50% of that, and ICUs need an empty bed.

Once again, you can talk to us today. Call us at intensivecareathome.com. Call us on one of the numbers on the top of our website, or call me directly on my mobile phone, 041 094 2230. You can also book a call with me on the website when you click on the schedule appointment button, or you can send me an email to [email protected]. If you are in the US, in Canada, in the UK, in India, anywhere around the world, and you want Intensive Care at Home, please reach out to us as well.

Also, a free checklist: Bring a Loved One Home From ICU for End-of-Life Care. We’ve put together a free family checklist covering the questions to ask the ICU team, the documents you need, the equipment and people to organize, and what to do in the first hours after death at home.

So let’s go through some frequently asked questions about today’s topic.

1. Can someone on BiPAP be discharged home from ICU? Yes, in many cases, when the treating team agrees, the right equipment and community doctors are organized, and 24/7 ICU-trained and critical care registered nurses are available to provide care at home with Intensive Care at Home.
2. Is stopping BiPAP at the end of life painful? It doesn’t have to be when it’s planned well. Doctors prescribe comfort medications in advance, and experienced ICU nurses manage breathlessness, agitation and pain before, during and after BiPAP is removed.
3. How long does someone live after BiPAP is removed? It varies a lot, from minutes to hours and sometimes days, depending on how much the person can still breathe on their own. The treating doctor can give you a better idea for your loved one.
4. Is withdrawing BiPAP the same as voluntary assisted dying? No, absolutely not. Withdrawing a treatment that is only prolonging dying is part of standard palliative care. Voluntary assisted dying is a separate legal process.
5. How quickly can Intensive Care at Home organize home care? Every situation is different, but we understand end-of-life situations are urgent. Again, call us on one of the numbers on the top of our website, or call me directly, or book a call with me through the website by clicking the schedule appointment button, or send me an email to [email protected], and tell us your loved one is in ICU so we can prioritize your inquiry.
6. Who pays for Intensive Care at Home at the end of life? It depends on the person’s circumstances. We’ll discuss the options with you directly. And like I said, the funding bodies, generally speaking, have an interest in cutting the cost of an ICU bed by approximately 50%, and ICUs have an interest in freeing up their in-demand ICU beds.

The bottom line is this. If your loved one is in ICU on BiPAP, and the doctors have said your family member won’t survive, you still have choices about where and how your mom spends her last hours or days. Coming home is possible in many cases, but it needs a plan, a doctor, the right equipment, and critical care registered nurses who’ve done this before.

To the reader who sent this question, I’m holding you and your mom in my thoughts. Please don’t wait. If home is what she would want, call us today.

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.