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“Can my father come home from ICU after stroke with ventilator and tracheostomy?”

My name is Patrik Hutzel from intensivecareathome.com, where we provide tailor-made solutions for long-term ventilated adults and children with tracheostomies, Home BIPAP (Bilevel Positive Airway Pressure), Home CPAP (Continuous Positive Airway Pressure)  ventilation, tracheostomy care without ventilation, cough assist management at home as well as ventilation weaning at home, Home TPN (Total Parenteral Nutrition), home IV potassium, home IV magnesium, home IV antibiotic infusion, central line, PICC (Peripherally Inserted Central Catheter) line, Hickman’s line, port management at home, PEG (Percutaneous Endoscopic Gastrostomy), PEJ (Percutaneous Endoscopic Jejunostomy) tube, nasogastric tube, nasojejunostomy tube, IDC (indwelling urinary catheter) and SPC (suprapubic catheter) management at home.

In today’s video update, I have an email from BB who says:

“Hi Patrik,

I tried to make this short but could not.

It is two months after my 71-year-old father had a stroke. He was in ICU for about two weeks after a procedure for decompression, and he has now been ventilated and with a nasogastric feeding tube ever since. He contracted pneumonia two times and another infectious disease. He still has a tracheostomy.

He could follow all commands, and he put up a big struggle when the nasogastric tube needed to be readjusted. He was expressive and understood everything. He was very weak from fighting off the infections, the antibiotics, the pneumonias, the fever, etc. He arrived with a fever that lasted quite a while, and he was given more antibiotics.

My current concern, he seems much less alert and responsive than he did before. There are days when he breathes on his own for about 12 hours at a time, which looks very painful. Could it be the medications that they started giving him? He seems to be doing much worse (to me) than before.

One thing that my family members and I agree on is that the medications might be sedating him, and the biggest concern is this Depalept. They have said they will remove the Depalept – against their own judgment – and they will reduce the dose by 50% for the first two days and then stop it completely after another two days. And now, if the doctors really do remove the Depalept this time, I’m very worried about this short 4-day schedule. Isn’t it important to taper it off more slowly?

They also said they gave him Depalept to stop his trembling. I didn’t hear it from them myself. If that’s true, I don’t understand why that would matter in this situation. They didn’t say it was to prevent seizures  or anything like that, though I don’t want to speak to them myself about this.

After 2 months in ICU and not much progress, can my father go home with Intensive Care at Home?”

So, first of all, Bb, I want to say thank you so much for reaching out and for trusting me with your father’s situation. I can hear your concern and frustration in your message, and I want you to know that what you’re experiencing is unfortunately very common in ICU but there is a solution. Let me address your questions and concerns one by one.

Your father has been through an absolute ordeal over the past two months. A stroke requiring decompression for surgery, followed by prolonged ventilation, tracheostomy, nasogastric feeding tube, multiple pneumonias, and infectious diseases – this is a very complex ICU case, but it’s certainly not a hopeless case.

What concerns me most from your description is that your father was previously alert, following commands, expressive and understanding everything, and now he’s becoming less responsive. This is a massive red flag, and you’re absolutely right to be concerned about the medications, particularly the Depalept, which is also known as valproate or sodium valproate.

So, the concern here is Depalept and sedation, because you’ve hit the nail on the head. Depalept can absolutely cause sedation, confusion, and decreased responsiveness, especially in elderly ICU patients. If they gave it to him just for “trembling” and not for seizure prevention or documented seizure activity, this is questionable at best.

Your instinct about the tapering schedule is also correct. A 4-day taper for someone who’s been on Depalept for what sounds like weeks is potentially too aggressive. Abrupt withdrawal of anti-epileptic medications can trigger seizures, even in patients who never had seizures to begin with. You need to have a direct conversation with the medical team about this, and you need to document everything.

The fact that your father was doing better before these medications and is now doing worse should be setting off alarm bells for everyone involved in his care.

Can your father come home with Intensive Care at Home? Bb, this is where I have excellent news for you because your father, especially after two months in ICU, can absolutely come home with Intensive Care at Home, even with a ventilator, tracheostomy, and nasogastric feeding tube.

Let me be crystal clear: we have successfully transitioned dozens of clients exactly like your father from hospital ICU to Intensive Care at Home and the outcomes are often significantly better than keeping patients like your dad in ICU.

Why? Because:

1. Home environment reduces infection risk

Your father has already had pneumonia twice, and another infectious disease. Hospital acquired infections are a major problem in ICU. At home, he’s not exposed to multi-drug resistant organisms and hospital or ICU superbugs.

Also, one other reason why your dad might have ended up with pneumonias is they’re not mobilizing him. I don’t know whether they do or they don’t, but at home I can guarantee you we will mobilize your dad, make him less prone to pneumonias.

2. Personalized care and attention

At home, your dad gets dedicated one-on-one nursing care instead of a nurse managing multiple critically ill patients. This means better monitoring, faster responses to problems and more consistent care.

3. Better neurological recovery

For stroke patients, especially the familiar home environment with family presence can and will significantly improve cognitive recovery and responsiveness. This could directly address your concerns about his decreased alertness.

It also brings me back to mobilization. Are they mobilizing him? Are they getting him out of bed? Are they stimulating him? Especially after a stroke, it’s important that the brain keeps getting stimulated in moderate doses, of course, you don’t want to overstimulate a patient. But it doesn’t sound to me like your dad is getting the stimulation he needs like mobilization, physical therapy, you haven’t mentioned that, which is something he will get at home if they can’t provide that in the hospital.

4. Reduced medication overload

In the home setting, we can work with doctors who understand that less is often more when it comes to sedating medications, especially in elderly patients recovering from stroke.

Bb, I also want you to look at our comprehensive guide and evidence-based Mechanical Home Ventilation Guidelines , and you can read them on our website at intensivecareathome.com and I’ll put a link in the written version of this blog.

This evidence-based resource shows you exactly how we safely manage patients on ventilation at home, including tracheostomy care management, ventilator weaning protocols, infection prevention strategies, emergency response procedures, 24-hour intensive care nursing care models, and of course, patient and family support in a holistic way, how you see fit.

So, what about the hospital staff not knowing about Intensive Care at Home? Here’s something critical you need to understand. If the hospital staff don’t know about intensivecareathome.com and the option of Intensive Care at Home, that doesn’t mean it’s not a genuine, proven, evidence-based option for your father, and it’s also why you’re reaching out.

We have hundreds of case studies, proven models of care, evidence-based policies and procedures, successful outcomes across multiple clients, partnership with medical equipment suppliers, partnership with doctors, and of course, a network of specialized home intensive care nurses.

As a matter of fact, we’re employing hundreds of years of intensive care nursing combined. No other provider can match that. We’re also the only provider in 2025 that has achieved third-party Intensive Care at Home accreditation. No other provider has the intellectual property to have achieved that level of accreditation.

So many ICU staff simply aren’t aware that Intensive Care at Home exists as an option, as a genuine alternative, because they’ve been trained in the hospital-centric model. But that doesn’t make it any less legitimate or effective – in fact, for many patients like your father, it is the much better option.

What about funding and cost? Well, I want you to remove this concern from your mind right now. Funding is not going to be a barrier to get your father home with Intensive Care at Home, and here is why.

With Intensive Care at Home, we’re cutting the cost of an ICU bed by at least 50%. That’s 5-0, often more. Think about it. ICU beds cost between $5,000 to $6,000 per bed day, some beds might cost up to $10,000 per bed day, depending on location. Intensive Care at Home typically costs 50% or less of that amount. Your father has already been in ICU for 2 months, that’s potentially anywhere between $300,000 to $600,000 in ICU costs.

Funding bodies, whether private insurance, government healthcare, NDIS or other payers should have a natural interest in Intensive Care at Home because it delivers better outcomes at half the cost. It’s a win-win situation.

We help families navigate insurance approvals, government healthcare funding, private pay options, cost comparison documentation, appeals processes. The financial case for Intensive Care at Home is so compelling that once funding bodies understand the cost savings, approval often follows quickly.

Next, your father’s breathing efforts. You mentioned that there are days when your father breathes on his own for about 12 hours at a time and it “looks very painful.” This is actually very important information. If your father can breathe spontaneously for 12 hours, this suggests his respiratory muscles are working. His neurological drive to breathe is intact. He may be ready for more aggressive weaning from the ventilator. However, if it looks painful, this could indicate improper ventilator settings, insufficient support during weaning trials, respiratory muscle fatigue, anxiety or air hunger, need for better weaning protocols.

In our Intensive Care at Home setting, we can optimize his ventilator settings, implement gradual weaning protocols, and provide the support he needs to come off the ventilator safely – if it’s medically appropriate.

Now, let’s also look at the reality of hospital ICU after two months. Let me be clear, Bb, after two months in ICU with “not much progress,” your father is at high risk for further hospital-acquired infections, including more pneumonias, ICU-acquired weakness, ICU delirium, psychosis, cognitive decline, pressure injuries, depression and psychological trauma, unnecessary medication burden.

Every additional day in hospital ICU increases these risks. The longer he stays, the harder recovery becomes. Like I said, and you can’t live your best life. You and your family are spending day and night in ICU.

But the good news is if there’s a dilemma, there’s a way out of this dilemma, and here’s what you need to do right now. Contact us again at intensivecareathome.com, fill out the contact form, call our phone number, and get access to all medical records and request a case evaluation.

Document everything about the Depalept. Get written documentation of why it was started, document the tapering schedule they’re proposing, ask about seizure precautions during withdrawal, request daily monitoring during the taper, and get access to all medical records because we also would need to know ventilator settings, medication lists, infection history, current status, neurological assessments, stroke imaging, tracheostomy details, nutrition, and nasogastric tube feeding plan.

Request a family meeting with the ICU team so that we can look at the discharge plan, talk about Intensive Care at Home as an option. We can go from there and take the next steps like we have done with many, many other clients. Have a look on our website and our case studies and all the questions that we’ve answered that will help you. It will encourage you, it will empower you, and then we can get your dad home as quickly as possible, especially since he’s been in ICU for two months, which is way too long, and you’ve seen all the negative side effects. Your instincts about taking him home are absolutely correct.

Now, with Intensive Care at Home, we are currently sending our ICU and critical care nurses into the home, 24 hours a day. We are providing the following:

• Home care services for ventilated adults & children with tracheostomies with critical care nurses 24 hours a day
• Genuine alternative to a long-term stay in intensive care or at long-term acute care
• Tracheostomy care for clients without ventilation
• Home care services for patients on non-invasive ventilation such as Home BIPAP (Bilevel Positive Airway Pressure), Home CPAP (Continuous Positive Airway Pressure)
• Home TPN (Total Parenteral Nutrition), which is also known as IV nutrition
• Home IV potassium and home IV magnesium infusions, IV fluids, and IV antibiotics
• Providing central line management, PICC (Peripherally Inserted Central Catheter) line management, Hickman’s line management, as well as port management at home.
• Providing nasogastric tube and PEG (Percutaneous Endoscopic Gastrostomy) tube management at home
• Use cough assist machines for our clients for airway clearance at home
• Palliative care services at home
• Ventilator weaning 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 Area Health District, their in-touch program, saving approximately $2,000 per patient that we keep at home, instead of them going to an emergency department.

That also means, we’re also in a position to cut the cost of an intensive care bed by around 50%. An intensive care bed costs between $5,000 to $6,000 per bed day. Our services costs between $2,500 to $3,000 per bed day, 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. Of course, quality of life is much improved surrounded by families and by a team of dedicated intensive care nurses in the home care setting instead of in an intensive care unit.

With Intensive Care at Home, we are currently operating all around Australia in all major capital cities as well as in all regional and rural areas. We work with NDIS (National Disability Insurance Scheme) clients all around Australia, TAC (Transport Accident Commission) and WorkSafe in Victoria, Department of Veteran Affairs (DVA) all around Australia. 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 having policies and procedures for Intensive Care at Home nursing and we’ve built all the intellectual property for Intensive Care at Home since 2012. No other provider in Australia 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, which enables us to look after the highest acuity adults and children in the community in Australia safely.

If you’re at home already and you’re watching this, or you’re stuck in an ICU long-term, or if you’re going to the hospital and ED all the time, and you realize that you don’t have the right level of support at home, or if you are stuck in an ICU, I’ll give you a real-world example today, how we can help you.

One of our first clients when we first got started in 2012, was a client who was at home initially on a ventilator with a tracheostomy with a support worker model 24/7. Of course, support workers are not equipped to look after a client at home on a ventilator with a tracheostomy. That is dangerous and it’s simply negligent. Having support workers looking after a client at home on a ventilator with a tracheostomy is like flying the airplane with a cabin crew instead of the pilot. Because anyone on a ventilator with a tracheostomy is at very high risk of medical emergencies 24/7, or even at high risk of dying if they don’t have a team of dedicated critical care nurses looking after them 24/7 at home. This is actually evidence-based and is documented in our Mechanical Home Ventilation Guidelines that you can find on our website at intensivecareathome.com.

Think about it, in an intensive care unit in a hospital, you wouldn’t have support workers looking after your critically ill loved one or after any critically ill patient on a ventilator with a tracheostomy. So, why would anyone in their right mind do that in the home care environment in the community?

So, this client at the time found out about us eventually, and the ICU that he was basically living in also knew about us and eventually reached out to us. We were proving our concept with this client very fast. When we worked with this particular client, we sent him critical care nurses, 24 hours a day. He never ever went back into ICU ever again, as long as we were working with this client.

We can do the same for you if you’re not safe at home and help you with keeping you at home predictably. Otherwise, we would not be in business. Again, the same is applicable for those stuck in an ICU, similar to this case study that I’ve just given you, or if you’re going back to ED all the time, please reach out to us. We can help you with taking you through the right steps, including how to get funding with different funding bodies.

This is also why we are providing NDIS Support Coordination. We have a team of NDIS Support Coordinators, and they have a wealth of knowledge. I’ve done an interview with Amanda Riches one of our NDIS support coordinators, and I’ll put a link to an interview with Amanda in the written version of this blog. 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 from another organization watching this, and you’re looking for nursing care for your participants, please reach out to us as well. If you need more evidence for nursing care, we are also writing NDIS nursing assessments with legal nurse critical care consulting nurses.

If you are a critical care nurse and you’re looking for a career change and you want to join a very progressive, dynamic, and high performing team of critical care nurses in the community, we’re employing hundreds of years of critical care nursing experience combined. You can join this high performing team if you are a critical care nurse.

If you are looking for a career change as a critical care nurse, we’re currently hiring for jobs for critical care nurses in Melbourne, Sydney, Brisbane, in Albury, Wodonga, in Bendigo, in Geelong, in Warragul in Victoria. If you have worked in critical care nursing for a minimum of 2 years pediatric ICU, ED, and you have already completed a postgraduate critical care nursing qualification, we will be delighted hearing from you.

I do have a disclaimer though, because we are offering a tailor-made solution for our clients, which includes regular staff, our clients also do want the same staff coming over and over again because they are so vulnerable and so special. That’s why we need regular staff. So, if you’re looking for agency work, where you can come and go, this will not be the right fit for you. We are 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 solid relationships with us and with our clients.

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 you 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, and you get the same level of care.

If you’re a hospital executive watching this and you have bed blocks in your ICU, ED, and respiratory wards, or for home TPN, please reach out to us as well. We can help you eliminate your bed blocks very fast.

If you’re in the U.S. and in the U.K. 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, 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, share this video with your friends and families, and comment below what you want to see next or what questions and insights you have from this video.

Thank you so much for watching.

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