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“Can my husband use BIPAP (Bi-level Positive Airway Pressure) at home with dementia after COVID (Coronavirus Disease) ICU?”

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

Now, Claire sends an email to me and she says:

“Hi Patrik,

I will look for my husband’s discharge report. My husband was in ICU at the hospital for 4 months after COVID, from March 2024 to September 2024, where he broke seven bones from many falls being unattended and finally broke his hip. We only had more medical problems and falls fractures in hospital. No hospital looked after his sleep problem or gastroparesis or other COVID-induced neurological problems.

My husband has now been home with me since September 2024 and we are facing major challenges. I was recently able to get a sleep study overnight and will try to send a copy to you of the report once I obtain it. The prescription for BIPAP is on it. The respiratory nurse and respiratory physio who are assigned to follow BIPAP patients in the community after sleep studies was to have an appointment with us next Wednesday. They are overworked and don’t have enough staff. We are left to figure it out after an appointment showing us the BIPAP.

Now, the community respiratory team, our homecare manager had a meeting with them, but has not briefed or included me, only saying that they do not know if it is safe for my husband to do BIPAP because he has dementia. Basically, I get the feeling that I’m not given a say so far. They’re trying to convince the respiratory physician and sleep doctor and respiratory nurse from the study to not have my husband do BIPAP, even though his heart, lungs, and body needs help for the hypercapnia and also not enough oxygen. No one has suggested they would help with the nursing plan overnight for us to assist us with trying the BIPAP properly.

We get 55 hours a week for homecare (support workers or healthcare aides), but when I read your website and look at your quality standards, my husband really needs 24/7 nursing care because of the hypercapnia and the BIPAP.

From, Claire.”

Now Claire, thank you so much for reaching out and for sharing your husband’s story. What you’ve been through and your husband has been through is absolutely heartbreaking, four months in ICU with COVID, 7 broken bones from falls, a broken hip, and now you’re dealing with sleep problems, gastroparesis, neurological problems, hypercapnia, and the community team is telling you they don’t know if BIPAP (Bi-level Positive Airway Pressure) is safe for your husband because he has dementia. I can absolutely hear your frustration in your message. I want you to know that you are not alone in this.

So, let’s look at understanding BIPAP and mechanical home ventilation first. So, what is BIPAP actually and why is it so important for your husband? BIPAP stands for bi-level positive airway pressure and it’s a form of non-invasive ventilation that helps people breathe at home when they have respiratory failure, hypercapnia, high CO2 levels, or low oxygen levels. Your husband has both high CO2 levels and low oxygen levels, and BIPAP is uniquely positioned to take care of them.

Your husband’s sleep study clearly showed that he needs BIPAP support. The fact that he has hypercapnia and low oxygen levels means his body is struggling to breathe properly, especially during sleep. This isn’t something you can just ignore. Hypercapnia can cause confusion, headaches, fatigue, and can actually make dementia symptoms worse. It can also put strain on his heart and other organs.

So, can someone with dementia use BIPAP at home? Now, here’s where I want to address what the community respiratory team is telling you. They’re saying they don’t know if it’s safe for your husband to use BIPAP because he has dementia. Claire, this is where I respectfully, but also firmly disagree with their approach. Having dementia does absolutely not automatically disqualify someone from using BIPAP at home. What matters is, does he tolerate the BIPAP mask? Can he keep the mask on with the appropriate support and supervision from critical care nurses? Is there adequate monitoring and nursing care in place? Because the reality is, not having BIPAP with dementia, especially with sleep apnea and hypercapnia and low oxygen will make the dementia worse.

The key word here is the right level of support. Yes, someone with dementia may need more help with BIPAP. They might try to remove the mask, they may not understand why they’re wearing it, or they might become agitated, but that doesn’t mean it can’t be done safely. It means you need the right level of nursing care and monitoring to make it work.

The problem with 55 hours per week of support workers, Claire, you mentioned you’re getting 55 hours a week of homecare with support workers or healthcare aides. Here’s the reality, 50 hours a week is not enough for someone with your husband’s level of complexity, especially when you’re trying to manage BIPAP with dementia, hypercapnia, gastroparesis, and ongoing neurological problem from COVID.

Let me break down the math for you. There are 168 hours in a week. If you’re getting 55 hours of care from support workers, that leaves 168 hours per week where you’re managing this completely on your own because your husband needs critical care nurses and not support workers. That’s not sustainable and frankly, it’s dangerous, not safe, and most likely life-threatening for your husband and not sustainable for you.

What your husband really needs is 24/7 nursing care. Based on what you’ve described and based on our evidence-based Mechanical Home Ventilation Guidelines that you can find on our website at intensivecareathome.com, your husband needs 24/7 critical care nurses, not just support workers or healthcare aides.

Here’s why:

1. BIPAP requires skilled monitoring.

According to the evidence-based Mechanical Home Ventilation Guidelines, patients on BIPAP need continuous monitoring of respiratory status, assessment of BIPAP settings and effectiveness, monitoring for complications like air leaks, skin breakdown, aspiration, check for pneumothoraces and prevent pneumothoraces, which is basically a hole in the lung.

The ability to troubleshoot equipment problems, recognition for respiratory distress, support workers and healthcare aides are not trained to do this level of monitoring. You need critical care registered nurses who understand mechanical ventilation.

2. Dementia and BIPAP is actually a much higher risk.

When you combine dementia with BIPAP, you need critical care registered nurses who can (1) assess whether your husband is becoming agitated or confused, (2) differentiate between dementia-related confusion and hypercapnia-related confusion, (3) redirecting gently if he tries to remove the mask, (4) recognize signs of respiratory distress in someone who can’t communicate clearly, (5) adjust care plans based on his cognitive status.

Another thing that can happen for a patient on BIPAP and dementia. They can actually wrap the circuits around their neck and can strangle themselves and even die from that. I’ve seen that unfortunately.

3. Gastroparesis increases the aspiration risk.

Your husband has gastroparesis, which means delayed stomach empty emptying. This significantly increases his risk of aspiration, breathing in stomach contents, especially when using BIPAP. Critical care is that nurses need to monitor for signs of aspiration. Position him properly during and after feeds, coordinate feeding schedule with schedules with BIPAP use, recognize early signs of aspiration pneumonia, and potentially initiate and advocate for home TPN.

What’s home TPN (Total Parenteral Nutrition)? I’m glad you’ve asked. TPN stands for total parenteral nutrition. It’s basically intravenous nutrition.  If the gastroparesis leads to your husband being malnourished, he will need TPN. If food can’t be digested and absorbed, he will need TPN, and again, that’s IV (intravenous) nutrition.

Critical care nurses would know what it is and they would know how to advocate for it. They would also know how to administer it at home, but it does need a doctor’s order. It also needs a central line, a PICC line, a Hickman’s line, or a port.

4. Your husband is at high falls risk with a history of multiple fractures.

Your husband has already broken seven bones from falls in hospital. Falls at home can be just as devastating. Critical care nurses can assess fall risks continuously, implement proper mobility and transfer techniques, recognize when he’s at higher risk, like when he’s more confused from hypercapnia, and they know how to manage hypercapnia.

Next question is, why is the current community team potentially hesitant? Claire, I really want you to understand why the community respiratory team might be saying what they’re saying. It’s not necessarily because of BIPAP with dementia can’t work, suppose it’s likely because they don’t have the resources to support you properly and they don’t have the know-how, how to advocate for you and your husband properly.

You mentioned they’re overworked and don’t have enough staff. When healthcare systems are stretched thin, they often default to the safest, easiest option, which in this case means not starting BIPAP at all, rather than providing the Intensive Care at Home support. You need to make it work safely.

But the good news is your husband’s medical needs don’t change based on what resources the public system can provide. He still has hypercapnia, he still has low oxygen levels, his heart, lungs and body still need the support that BIPAP provides. The good news is you do get a say in this, and we will help you.

Claire, you mentioned feeling like you’re not given a say so far. I want to be crystal clear about this: You absolutely get a say in your husband’s care. You are his advocate and we are by your side every step of the way. If you are his substitute decision maker, you have the legal right to be involved in all decision making about his treatment.

The fact that they had a meeting with the homecare manager but didn’t include you is completely unacceptable. You have the right to attend all meetings about your husband’s care, review the sleep study results yourself, speak directly to the respiratory physician about the BIPAP recommendation, request a second opinion if you disagree with their assessment, ask for a written care plan that explains their concerns and recommendations, and simply don’t let them make decisions about your husband behind closed doors. You have every right to be at the table.

So, what can we do to help? At Intensive Care at Home, Claire, this is exactly the kind of situation where our team at Intensive Care at Home can make. You mentioned that the hospital staff are overworked and don’t have enough support. The good news is that we have a full team of highly qualified clinicians, including ICU nurses, ICU doctors, and critical care specialists who work with families like yours and their loved ones.

Here’s what we can provide: 24 hours critical care nursing at home. We provide around the clock critical care registered nurses who are experienced with mechanical ventilation and BIPAP management, caring for patients with dementia and cognitive impairment, complex medical conditions like gastroparesis, preventing falls and managing high risk patients and also, like I said earlier, advocate for TPN, advocate for IV nutrition, advocate for the central line, the PICC line, the Hickman’s line or the port to get TPN administered if that’s where your husband is heading. We also manage the BIPAP setup and the monitoring.

Our ICU nurses can work with your husband’s respiratory physician to optimize BIPAP settings and we know how to properly use BIPAP. We monitor the effectiveness of the BIPAP and make adjustments as needed, troubleshoot any equipment issues, document his response to treatment, and it’s comprehensive care coordination. We don’t just provide nursing care, we coordinate with all of your husband’s healthcare providers to ensure everyone is on the same page. We can communicate with the respiratory physician about BIPAP tolerance and effectiveness, work with your husband’s respiratory physician closely, get a gastroenterologist, involved if your husband gets malnourished and needs TPN, and provide detailed documentation to support continued BIPAP use.

Now, let’s also look at dementia-specific care strategies. Our nurses are trained in dementia care or can be trained, because it’s about gentle redirection and validation techniques, create a calm, structured environment that reduces agitation, help your husband adjust to BIPAP gradually, recognize when confusion is related to dementia versus hypercapnia.

Again, the evidence for home mechanical ventilation is that, I want to point you to our evidence-based Mechanical Home Ventilation Guidelines. These guidelines clearly show that evidence-based home mechanical ventilation, including BIPAP can be done safely at home when you have proper patient selection. Your husband has clear medical indications for BIPAP use, adequate equipment and supplies, BIPAP machines are reliable and widely available. Critical care nurses, 24 hours a day, this is where our team comes in. Emergency protocols, we have clear plans for what to do if problems arise, ongoing monitoring and adjustment, regular assessment and communication with doctors. Because the research clearly shows that patients can do very well on home mechanical ventilation with BIPAP when these elements are in place.

The missing piece in your situation right now is adequate 24 hour CCRN nursing support with ICU nurses, and that’s something we provide. We also provide the advocacy for our service or for the funding for our service. Again, we’re cutting the cost of an ICU bed by 50%. It’s a win-win situation for everyone, including for the health insurances or for the funding bodies.

So Claire, here are my recommendations for what you should do right now. Get the sleep study report, make sure you get a copy of the report and the BIPAP prescription. Once again, you have the right to get this information, and you need to see exactly what the respiratory physician recommends. Request a family meeting with the respiratory physician and have us there, also with the homecare manager.

What other specific concerns about BIPAP with dementia? But irregardless of what they say, we have the solution to it. So, document everything, of course, your husband’s symptoms, confusion, headaches, fatigue, how his oxygen and CO2 levels are affecting him, any incidents or problems that occur, and all conversations with healthcare providers.

Contact us as the next step. You’ve already reached out, but we need to get on a call as the next step because we can review your husband’s medical records, make a strong argument for why he needs 24-hour intensive care nurses because of the BIPAP and the dementia, give you a clear plan forward, and coordinate with his doctors to implement the BIPAP safely and coordinate with the funding body to get the funding that your husband needs.

So, don’t waste any time. Reach out to me again so that we can take the next steps because we have a full team of highly qualified clinicians, ICU nurses, ICU doctors. We have access to respiratory physicians as well, respiratory physiotherapists as well. We work with families like yours every day, 365 days of the year.

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.

Take care for now.