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My name is Patrik Hutzel from intensivecareathome.com, where we provide tailor-made solutions for long-term ventilated adults and children with tracheostomies where we also provide tailor-made solutions for long-term ventilated adults and children with BiPAP (Bilevel Positive Airway Pressure) and CPAP (Continuous Positive Airway Pressure). Tailor-made solutions for long-term tracheostomy clients on BiPAP and CPAP, adults and children, home ventilation weaning, home cough assist management, home TPN (Total Parenteral Nutrition), and home intravenous (IV) potassium, home IV magnesium, home IV antibiotics, home IV fluid management, central line, PICC (Peripherally Inserted Central Catheter) line, Hickman’s line and port management at home, Percutaneous Endoscopic Gastrostomy (PEG) tube, PEJ (Percutaneous Endoscopic Jejunostomy) tube, nasogastric tube, nasojejunostomy tube management at home, as well as suprapubic catheter (SPC) and indwelling catheter (IDC) management at home, including palliative care.

Today, I want to answer a question from Michael, who says:

Hi Patrik,

“Our 47-year-old son is currently in the ICU and the hospital staff say he is a good candidate for transition to our home. He has been on a ventilator for approximately 10 months with varying degrees of ventilation weaning success. He tolerates spontaneous breathing pressure support trials per day, but experiences apnea episodes when sleeping.

We are interested in bringing him home and we would like to continue weaning efforts in the home setting. Is Intensive Care at Home an option? Do you do weaning and extubation in your company, Intensive Care at Home?”

Kindly, Michael.

 

Thank you so much for reaching out, Michael. What a powerful question. I can hear both the hope and the urgency in it. The short answer is yes, ventilation weaning at home is absolutely possible, and yes, Intensive Care at Home is absolutely an option for your son. Let me walk you through everything you need to know.

What is ventilator weaning? Why can it happen at home? Ventilator weaning simply means the gradual, structured process of reducing a patient’s dependence on a mechanical ventilator, with the ultimate goal of either breathing fully independently or transitioning to a safer, less invasive form of breathing support, such as a mask or non-invasive ventilation.

Here is what many families and even many hospital teams do not fully appreciate: weaning does not have to happen inside a hospital or an ICU. In fact, for long-term ventilated patients like your son, the home environment can be significantly more conducive to successful weaning than an ICU. Here is why:

Better sleep quality: ICU environments are notoriously noisy, with constant alarms, lights, shift changes, and interruptions. Poor sleep is one of the biggest barriers to successful ventilator weaning.

Significantly reduced risk of hospital-acquired infections: Patients who have been in the ICU for 10 months, like your son, are at significant risk of picking up additional infections. Home removes that risk.

Improved psychological well-being: Being at home, surrounded by family and familiar surroundings, dramatically improves patients’ motivation, comfort, and overall healing.

Consistency of care: Intensive Care at Home critical care nurses know your son’s individual baselines, his normal breathing patterns, his triggers. That consistency is priceless for ventilation and tracheostomy weaning.

Patient-paced weaning: Unlike in a busy ICU where weaning protocols are driven by bed pressure, resource constraints, and financial constraints, with Intensive Care at Home, we can pace weaning entirely around your son’s capacity and progress. This is not a theory, it has been proven over decades of intensive home care practices in countries like Germany and Australia. You can read more about our evidence-based approach in our evidence-based Mechanical Home Ventilation Guidelines on our website at intensivecareathome.com.

Also, while we are talking about quality, please know that we are the only service in Australia in 2026 that has achieved third-party accreditation for Intensive Care at Home nursing. No other service provider has achieved this high level of accreditation, and has the level of expertise we are bringing to the table. We are employing hundreds of years of intensive care nursing experience combined on our team, because that is what enables us to look after the highest acuity clients in the community in Australia safely. We have the accreditation, the team, the level of expertise that is needed, and of course the experience.

Clinical read of your son’s situation. Based on what you have described, Michael, here is my clinical read of your son’s situation. Your son has been on a ventilator with a tracheostomy for approximately 10 months. He can tolerate spontaneous breathing trials on pressure support during the day, which is very encouraging. This tells us his respiratory muscles are not completely atrophied and that there is real potential for weaning progress.

However, he experiences apnea episodes during sleep, meaning he stops breathing on his own when he transitions into sleep. This is not uncommon for long-term ventilated and tracheostomy patients and is a well-recognized clinical challenge. It typically means his respiratory control — the automatic drive to breathe — is not yet reliable enough to sustain breathing without ventilator support during sleep. This is exactly the kind of complex, nuanced clinical situation that intensivecarehotline.com and Intensive Care at Home are built for.

Here is what managing this at home looks like with our service:

1. Daytime spontaneous breathing trials continue: Structured, progressive, and monitored closely by our critical care nurses. We document every trial, every tolerance window, and adjust the plan accordingly.
2. Overnight ventilator support: During sleep, your son remains safely supported on the ventilator to prevent apnea episodes and ensure adequate oxygenation and carbon dioxide clearance.
3. Gradual overnight weaning: Over time, as your son’s respiratory control improves, we begin extending the periods of minimal or no ventilator support during sleep, under close monitoring with pulse oximetry and capnography.
4. Goal — decannulation: Whether that means removing the ventilator entirely or transitioning from invasive tracheostomy ventilation to non-invasive mask ventilation such as BiPAP, CPAP, bilevel positive airway pressure (BPAP), or auto-titrating positive airway pressure (APAP), is determined by your son’s progress and clinical picture.

Does Intensive Care at Home do weaning at home, tracheostomy decannulation or extubation? Yes, we absolutely do. Ventilation weaning management at home is one of our core services. Our critical care nurses, all of whom have a minimum of two years of ICU and critical care nursing backgrounds, are trained and experienced in:

• Pressure support weaning trials and spontaneous breathing trial (SBT) protocols.
• Monitoring of oxygen saturation, respiratory rate, tidal volumes, and work of breathing.
• Reading of arterial blood gases (ABGs).
• Overnight sleep monitoring for apnea and hypoventilation.
• Cough assist management critical for secretion clearance during weaning.
• Tracheostomy management including downsizing and eventual decannulation.
• Coordination with ICU consultants, respiratory physicians, and pulmonologists for extubation and weaning decisions.

 

We work collaboratively with your son’s medical team, his hospital physicians, respiratory specialists, and treating doctors to ensure the weaning plan is safe, structured, and evidence-based. You can read in detail about the evidence behind mechanical home ventilation, safety, and weaning in our evidence-based Mechanical Home Ventilation Guidelines.

What makes Intensive Care at Home different from an ICU? It is a critical distinction, Michael, and one I want to be clear about. Intensive Care at Home is not a nursing home. We are not a rehabilitation facility. We are not a standard community nursing service. We are an intensive care nursing service delivered in the home setting. Our nurses are critical care nurses, they have the same caliber of nurses your son has in the ICU right now, except they come to your home 24 hours a day and provide that same standard of monitoring, assessment, and clinical intervention in the home environment.

This is why we are able to manage patients on invasive mechanical ventilation, patients requiring overnight weaning protocols, patients with apnea episodes, patients with complex tracheostomy needs, and patients who still require ICU-level clinical oversight, but in the comfort of your own home. This is also why we are the only and first fully third-party accredited Australian provider of intensive home care nursing services meeting Australian healthcare standards. Accreditation matters, and quality matters, because it means our clinical governance, our staff qualifications, our protocols, and our care standards are independently and third-party verified.

 

How does the transition from ICU to home actually work? This is something families often wonder about, and understandably so. The idea of bringing a ventilated loved one home can feel overwhelming. Here is what the process looks like:

1. Initial consultation: You contact us by phone or by email. Details are on our website at intensivecareathome.com. We have a detailed conversation about your son’s current clinical status, the hospital’s assessment, the home environment, and what support is in place. This is at no cost and no obligation.
2. Clinical assessment: We review your son’s medical records, speak with his ICU team, and conduct a clinical assessment to determine what our service needs to provide to keep him safe at home, predictably and permanently.
3. Home assessment: We assess your home power supply, space for equipment, ventilator and suction machine placement, access for nurses, and so on.
4. Equipment set-up: We coordinate the ventilator, suction machines, monitoring equipment, backup equipment, and consumables required. As per our evidence-based Mechanical Home Ventilation Guidelines, your son needs 24-hour intensive care nursing per day. A backup ventilator is mandatory, and we ensure this is in place.
5. Nursing team establishment: We establish a consistent team of critical care nurses rostered to your son 24 hours a day, 7 days a week. Consistency of nursing staff is one of the most important predictors of good outcomes at home. You can be involved in staff selection so that we can find the right fit for your home.
6. Handover from hospital and ICU: We work directly with the ICU team to ensure a safe, structured clinical handover.
7. Ongoing weaning management: Our nursing team implements and monitors the weaning plan, communicates progress to the treating medical team, and adjusts the plan based on your son’s response.

 

Funding

How does Intensive Care at Home get paid? This is often the first question families ask and it’s a fair one. Funding for our service can come from a number of sources depending on where you are and what funding is available:

National Disability Insurance Scheme (NDIS) in Australia:

• If your son has an NDIS plan that includes specialist support coordination and nursing support, this will fund our service.
• Transport Accident Commission (TAC): If applicable, we are a TAC-approved provider.
• Department of Veterans’ Affairs (DVA).
• Private health insurance.
• Private funding: Some families fund our service privately.
• Insurance or compensation claims, depending on the cause of your son’s condition.

 

The best way to find out what applies to your situation is to contact us directly so we can have a proper conversation about what is available to you. Keep in mind that an ICU bed costs $5,000 to $10,000 per bed day, depending on location and condition, and we can reduce that cost to approximately 50% of the cost of an ICU bed, meaning it is in the interest of any funding body.

What are realistic outcomes for your son? With 10 months on a ventilator and demonstrated capacity for daytime spontaneous breathing trials, your son’s situation has real potential. Many patients in similar situations have been successfully weaned — either fully off the ventilator or to a non-invasive mask at night only — when managed in the right environment with the right clinical support.

However, every patient is different. He might end up being liberated from the ventilator during the day, keeping the tracheostomy in place, and then being ventilated overnight. Some patients wean fully. Some patients partially wean — for example, breathing independently during the day but requiring ventilation support overnight. Some patients may remain ventilator dependent long-term, and even in that scenario, home is absolutely the right place to be, with a quality of life that simply cannot be replicated in an ICU or hospital.

What I can tell you with confidence is this: the home environment with expert intensive care nurses gives your son the best possible chance of maximizing his respiratory recovery and his quality of life.

The bottom line Michael, is Intensive Care at Home an option for your son? Absolutely yes. Do we do weaning, extubation, and decannulation of tracheostomy at home? Absolutely yes.

Your son’s situation — ventilated for 10 months in the ICU, tolerating daytime spontaneous breathing trials, with apnea during sleep — is exactly the kind of complex clinical picture we manage safely every day in the home setting, and have been doing so safely since 2012.

The next step is simple. Contact us for a phone call at intensivecareathome.com.

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.