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“COPD (Chronic Obstructive Pulmonary Disease)  patient on a ventilator in ICU: Hospice decision after only 3 days, or is Intensive Care at Home an option?

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 provide tailor-made solutions for home BIPAP (Bilevel Positive Airway Pressure), home CPAP (Continuous Positive Airway Pressure), home 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, as well as port management at home, cough assist management and ventilation weaning at home, palliative care at home, PEG (Percutaneous Endoscopic Gastrostomy), PEJ (Percutaneous Endoscopic Jejunostomy) tube, nasogastric tube and nasojejunostomy tube management at home.

Now, today I have a question here from Christy, and that’s a really important one that, unfortunately, I see far too often in ICU before patients actually can come home with Intensive Care at Home.

So, here’s the question from Christy:

“Hi Patrik,

My mother is diagnosed with COPD and required use of an oxygen machine at home. She had complained and began panicking from not being able to catch her breath 3 days ago, and she’s now on the ventilator in ICU. She was admitted for extreme shortness of breath, O2 sats (saturation) was in the 50s. They sedated her and placed her on a ventilator with a breathing tube.

Three days later, the ICU doctors expressed there are no other options and placed her on hospice and they are doping her up with sedatives and propofol and morphine until she dies from organ failure. Is there really nothing else we can do?”

Well, this is very concerning, and here’s why. Christy, I’m very sorry you’re going through this with your mom. This situation is very concerning because three days is far too early to make a hospice decision for your mom, who’s a COPD patient on a ventilator. Even 3 weeks would be too early, sometimes 3 months is too early. Let me break this down for you.

COPD patients can recover from ventilation, and first of all, COPD patients even with severe exacerbations, can and do recover from mechanical ventilation. Yes, COPD is a chronic condition, but an acute exacerbation doesn’t automatically mean it’s the end of the road. Your mom came in with oxygen saturations in the 50s, that’s certainly critically low, no dispute about that, but it doesn’t mean she can’t recover with proper intensive care treatment.

Like I said, three days on a ventilator is not enough time to determine that there are “no other options.” That’s barely enough time to stabilize the patient, treat the underlying infection, if there is one, optimize ventilator settings, give steroids and bronchodilators time to actually work, and address any other complications that might be there. In fact, many COPD patients need a week or more on the ventilator to recover from severe exacerbation, some need even longer.

So what questions should you be asking? Here are some critical questions you need to ask the ICU team immediately:

1. What specific treatments have been tried? Have they given steroids, antibiotics if there’s an infection, bronchodilators?
2. Are they managing ventilator settings appropriately for a COPD patient? Are they doing arterial blood gases ?
3. What are the actual lung mechanics? What’s the compliance? What’s the resistance?
4. What are the blood gases showing now compared to admission? Has there been any improvement at all? Even small improvements matter in the first few days.
5. Why hospice after only three days? What is the medical justification for giving up so quickly? What about a tracheostomy and the weaning trial? If your mom needs longer term ventilation, a tracheostomy could be an option to help with weaning and give her simply time if she can’t be weaned off the ventilator.
6. Has a pulmonologist or a respiratory physician been consulted? COPD is a respiratory disease, you need a lung specialist involved, not just general ICU doctors.
7. Have they stopped sedation  and opiates so that she can actually wake up and get a baseline so that you can see what you can do neurologically?

Therefore, the hospice decision seems to be absolutely premature. The fact that they’ve moved to hospice with sedatives, such as propofol, and opiates, such as morphine, after just three days suggests they may have given up too quickly.

Now, I’m not there with you, I don’t have access to your mom’s medical records and I can’t give you specific medical advice without any access to the medical records. But, from what you’re describing, this seems extremely premature. I have worked in critical care nursing for over 25 years and it’s almost unheard of for a situation like that.

So, what are your options? Here’s what you can do right now. Challenge the hospice decision. You have the right to question this decision, ask for a family meeting with the ICU team, get access to all medical records, bring a list of questions, ask them to justify why they believe there are no other options after only three days. Get a second opinion, you can request a second opinion from another intensivist or pulmonologist or respiratory physician.

Some ICUs have ethics committees that can review cases where families disagree with medical teams’ recommendations. You can take it there, but you need to be the one taking it there. Of course, request continued ICU treatment if you believe your mom deserves a chance, and therefore more time and treatment. You can request that they continue intensive care. You can withdraw from hospice if that’s been put in place prematurely and without you having done any research. You can ask for a transfer to another hospital if the hospital isn’t willing to continue treatment. And of course, look at long-term options such as home ventilation with BIPAP, CPAP, or if your mom needs a tracheostomy, then with either a tracheostomy at home without ventilation or tracheostomy and ventilation. Also, your mom might need a tracheostomy and no ventilation, it really all depends.

So, with home BIPAP or CPAP, many COPD patients manage very well at home with non-invasive ventilation such as BIPAP or CPAP. This can be used for overnight support or even more frequently if needed. Some patients with severe COPD live for years with home BIPAP support.

Next, home tracheostomy and ventilation. If your mom needs invasive ventilation longer term, a tracheostomy with home mechanical ventilation is absolutely an option. We’ve worked with some COPD patients who’ve gone home on ventilators through a tracheostomy at least for many months or even years with a good quality of life.

The key is getting your mom stable first, then working on weaning and then if needed, planning for long-term ventilation, whether it’s on BIPAP without a tracheostomy or on mechanical ventilation with a tracheostomy. But you can’t even explore these options if the hospital gives up after three days very prematurely.

Red flags in this situation. So here are some red flags I’m seeing:

• Too quick to go to hospice,
• Three days is not enough time,
• No mention of specific treatments, what have they actually tried? 3 days again is not even long enough to try some treatment.
• Heavy sedation immediately. This makes it impossible to assess neurological status and to wean.
• No discussion of alternatives (tracheostomy, prolonged weaning, transfer, Intensive Care at Home, and so forth)

Once again, get access to the medical records.

Christy, here’s the bottom line: Don’t give up on your mom. Three days is far too early to make life or death decisions for a COPD patient on a ventilator. As a bonus tip, Christy, 70 to 90% of intensive care patients survive, which means the odds are in your mom’s favor. So, that’s the part that intensive care teams are not telling you. What they’re also not telling you is that they might simply need the ICU bed quickly, which is why they moved your mom to hospice, but I can’t believe they moved your mom to hospice without you giving consent.

I’ve seen patients in worse situations, Christy, than what you’re describing, recover and go home. I’ve seen COPD patients on ventilators for weeks who eventually got off the ventilator and went home. Your mom deserves more time, more care, and more treatment, and you deserve answers from the medical team about why they’re giving up so quickly.

Now, if you’re feeling overwhelmed and you need someone in your corner who understands ICU, can help you with the right questions, challenge the ICU team when needed, and explore all your options, including Intensive Care at Home, we can take your mom home on a ventilator with a tracheostomy or without a tracheostomy.

We review your mom’s case in detail, help you prepare for the meetings, guide you through the questions to ask, explore options like a tracheostomy and home ventilation, supporting you in getting a second opinion, and getting your mom home if that’s what you want.

If you need urgent help, just give us a call at intensivecareathome.com or send us an email to [email protected].

Remember Christy, even if your mom needs long-term ventilation, there are options like home BIPAP, home CPAP, or even home tracheostomy with ventilation that will give your mom more time and potentially a good quality of life outside of the ICU. If she really does need palliative care or hospice care, even that would be much better and much nicer at home.

I hope this helps and I’m thinking of you and your mom during this incredibly difficult time.

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.