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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 at home with 24-hour critical care nurses, where we provide tailor-made solutions for long-term ventilated adults and children on BiPAP (Bilevel Positive Airway Pressure) and CPAP (Continuous Positive Airway Pressure) ventilation at home with 24-hour critical care nurses, where we provide tailor-made solutions for adults and children with tracheostomies at home with 24-hour critical care nurses, where we provide home ventilation and home tracheostomy weaning when medically appropriate. We provide cough assist management at home. We provide home TPN (Total Parenteral Nutrition), home IV (intravenous) antibiotics, home IV fluids, and home electrolyte replacement therapy, like magnesium, potassium and other electrolytes. We provide home central line, PICC (Peripherally Inserted Central Catheter) line, Hickman’s line and port management at home. We provide home nasogastric tube, nasojejunostomy tube, PEG (Percutaneous Endoscopic Gastrostomy) and PEJ (Percutaneous Endoscopic Jejunostomy) tube, IDC (Indwelling Catheter) and SPC (Suprapubic Catheter) management at home, as well as palliative care management at home. We’re also providing Level 2 and Level 3 NDIS (National Disability Insurance Scheme) support coordination, as well as TAC (Transport Accident Commission) and WorkSafe case management.

Picture this. Your dad has just come home after 6 weeks on a ventilator in ICU. You thought the hard part was over, but he’s not getting better. He has stage 3 bed sores. He’s breathing heavily, and you don’t know what to do. If that’s you, stay with me, because in this video I’m going to show you what might be going on, when it’s an emergency, how BiPAP can help with COPD at home, and how to manage all of this safely.

 

So today’s question comes from a concerned daughter. She writes:

 

“Hi Patrik,

My father is 62 years of age and was in ICU on a ventilator for 6 weeks because of COPD and asthma. Now we got him home, but he still has no recovery. He has stage 3 bed sores and heavy breathing. What can we do at home to help him recover, and how do we manage his bed sores and breathing difficulties safely?”

Thank you so much for your question. I can only imagine how worried you must be.

 

And before I go on: if your loved one is at home after ICU and you need help right now, or if your loved one is in ICU right now and you are thinking about Intensive Care at Home, or if you’re at home already and you don’t have enough support, you don’t have the right support, you’re struggling with funding, or you’re struggling to get nurses, please reach out to us at our website, intensivecareathome.com. Call us on one of the numbers on the top of our website, or schedule a call with me by clicking on the schedule appointment button, or simply send us an email to [email protected]. And I’ve put together a free checklist, Home From ICU With COPD: The Breathing and Bed Sore Safety Checklist. The link is in the show notes.

 

Now, I have to be very clear with you. This question is somewhat incomplete. I don’t know whether your dad had a tracheostomy. I don’t know whether he came home on oxygen, on BiPAP or on high flow. I don’t know what heavy breathing means for him. Is he breathless at rest? Is he drowsy? Is he confused? I don’t know whether anyone has checked his carbon dioxide level since he got home, or who is actually looking after him. And I don’t know where you live or how his care is funded.

 

So please take this video as general information to help you ask the right questions. It is not medical advice for your dad, because the information that you’ve presented to me is incomplete. His doctors and his treating team need to assess him. We can certainly help you along the way, but there’s not enough information in your message to give you a complete answer.

 

But let me cover this first, because it’s the most important part. Call triple zero (000), or your local emergency number, 911 if you’re in the US, straight away if your dad:

1. Is very short of breath at rest and can’t finish a sentence.
2. Has blue or gray lips.
3. Is unusually drowsy, confused or hard to wake.
4. Has chest pain.
5. Has a fever, or a wound that’s suddenly red, hot, smelly or oozing, which can certainly be the case when he’s got stage 3 bed sores.

Drowsiness and confusion in someone with COPD can mean carbon dioxide is building up. Please do not wait for a GP (General Practitioner) appointment here. That’s also assuming you don’t have services like Intensive Care at Home, with 24-hour critical care and ICU nursing, in place that can escalate to other health professionals. Call triple zero.

 

So what’s going on after 6 weeks on a ventilator? Usually several things at once:

1. ICU-acquired weakness. Weeks of sedation and bed rest waste the muscles, including the breathing muscles.
2. COPD (chronic obstructive pulmonary disease) with possible ongoing CO2 (carbon dioxide) retention. Some people leave hospital still holding on to carbon dioxide, and that makes them breathless, tired and drowsy.
3. PICS (Post-Intensive Care Syndrome). Weakness, poor sleep, anxiety and low mood.
4. The stage 3 bed sores. At stage 3, the pressure injury goes through the skin into the fat underneath. It is a very serious wound. It uses a lot of the body’s protein and energy, and it can be very painful, which makes it harder to move, eat and sleep. So the breathing and the wounds are connected.

The next question is, why might he not be recovering? Possible reasons include:

1. Untreated CO2 retention, especially overnight.
2. Not enough nutrition and protein.
3. Not enough rehabilitation.
4. A chest infection, or secretions that aren’t being cleared.
5. An infected wound.
6. Low mood or depression.
7. Quite often, a discharge plan that simply didn’t match how unwell he still is.

 

And now, this is the big one. For many patients with COPD and asthma, BiPAP at home can be a game changer. BiPAP gives a higher pressure when you breathe in and a lower pressure when you breathe out, so it actively helps the breathing muscles and helps blow off carbon dioxide. CPAP gives one steady pressure and is mainly for sleep apnea, although some people have both.

 

And the evidence is very strong. In the HOT-HMV (Home Oxygen Therapy–Home Mechanical Ventilation) trial, published in JAMA (Journal of the American Medical Association) in 2017, COPD patients who still had high CO2 a few weeks after a hospital admission, and who used home BiPAP plus oxygen, went significantly longer before being readmitted or dying than those on oxygen alone.

 

A German trial in The Lancet Respiratory Medicine in 2014 showed improved survival with home non-invasive ventilation in COPD with chronic CO2 retention.

And when you look at our own Mechanical Home Ventilation Guidelines on our website, which are evidence-based and best practice guidelines, actually based on the German ventilation guidelines and international research, they explain exactly when home ventilation is appropriate and who should provide that care. I’ve put a link to those evidence-based, best practice home mechanical ventilation guidelines in the show notes.

 

But, and this is important, BiPAP is never DIY. It has to be prescribed by a respiratory or sleep physician, or an intensive care specialist, after proper assessment, usually including an arterial blood gas and a sleep study. And if your dad is on oxygen, use it exactly as prescribed, because in some people with COPD, too much oxygen can make CO2 retention worse.

 

One more thing: BiPAP masks themselves can cause pressure injuries on the nose and face. So mask fit and rotating mask types really matter.

Now let’s talk about the bed sores. Stage 3 pressure injuries need a clinician’s plan, not dressings from the chemist.

1. Ask for a proper wound assessment, with measurements and photos, so you can see whether it’s healing.
2. Get the right pressure-relieving mattress and cushion.
3. Reposition him on a schedule his care team sets, and keep weight completely off the wound.
4. Keep his skin clean and dry.
5. Get a dietitian involved, because healing wounds and COPD both burn a lot of energy and protein.
6. Manage his pain before dressing changes.
7. Watch for infection. More redness, heat, swelling, smell, discharge, bleeding or fever means urgent medical attention is needed.

A few more things that will help:

1. A written COPD action plan from his GP, respiratory physician or ICU specialist.
2. Checking his inhaler technique.
3. Physio for breathing exercises and airway clearance, then pulmonary rehab when he’s ready.
4. Sitting him upright.
5. Asking about follow-up for mood, sleep and anxiety after ICU.

 

Next, and I say this in nearly every video: get a copy of the medical records. Knowledge is power. Ask for the discharge summary, his latest blood gases and CO2 levels, whether BiPAP was trialed before discharge, and if not, why not, the wound charts, and his oxygen prescription. With that information, you can ask the right questions, like, “Should Dad be assessed for home BiPAP?”

 

So that leads automatically to the next question: why do critical care or ICU nurses matter at home? I always use the analogy of a pilot in the cockpit. You wouldn’t want someone without pilot training flying the airplane, even on autopilot. Take someone who has just had 6 weeks of ventilation, who’s on or may need BiPAP, and who has serious wounds from pressure sores. Situations can change very quickly. The mask leaks. CO2 creeps up overnight because of that mask leak. Secretions build up. The wound gets infected. You want someone at the bedside who picks that up early, and ideally knows how to prevent it.

 

That’s why our best practice and evidence-based mechanical home ventilation guidelines say that home ventilation must be delivered by critical care trained nurses with at least 18 months ICU experience. But our ICU nurses have at least 24 months ICU experience, and around 75% have a postgraduate critical care nursing qualification. As a matter of fact, we’re employing hundreds of years of critical care nursing experience combined in the community, meaning we’re bringing the highest skill level into the community, hands down. That, in turn, enables us to look after the highest acuity patients in the community safely.

Well, the good news is, at Intensive Care at Home, our critical care registered nurses provide 24/7 care at home for adults and children on BiPAP or CPAP, with tracheostomies and on home ventilation, or with tracheostomies without ventilation. We:

1. Manage the BiPAP and the mask 24/7, including preventing mask leaks.
2. Manage the oxygen as prescribed.
3. Monitor for early deterioration, and prevent deterioration.
4. Provide wound care under the treating team’s plan.
5. Help with secretion clearance and cough assist when appropriate.
6. Work closely with your doctors, wound nurses, physios, dietitians, speech therapists, etc.

We’ve been doing Intensive Care at Home now since 2012, all around Australia, in all states and territories. And like I said, we’re employing hundreds of years of critical care nursing experience combined. Most of our nurses have, on average, at least 8 years ICU experience. No other provider can match the level of skill that we’re bringing into the community.

 

And to my knowledge, in 2026, we are the only third-party accredited Intensive Care at Home nursing service in Australia, accredited specifically for intensive care nursing at home. We are certified to ISO (International Organization for Standardization) 9001:2015, as well as NDIS registered, for the delivery of intensive care nursing services at home, including to ventilated patients. You can see our certificates and accreditation on our website at intensivecareathome.com/accreditation-quality.

 

Depending on eligibility and access, funding may come from the NDIS, DVA (Department of Veterans’ Affairs), TAC, WorkSafe, private health insurance, departments of health, private funding, etc. Your dad is under 65, so the NDIS may be an option to explore, but we wouldn’t be able to promise that from here. Talk to us about your situation.

 

So the bottom line is this. Six weeks on a ventilator, COPD and asthma, stage 3 bed sores and heavy breathing is a high-risk situation, and no recovery at home is a sign to act, not to wait. Get an urgent medical review. Ask whether your dad should be assessed for home BiPAP. Get a proper wound and nutrition plan. Get the medical records. And if he needs more than your family can safely provide, which sounds like it is the case here, call us on one of the numbers on the top of our website at intensivecareathome.com, or book a call with me by clicking on the schedule appointment button. You can also call me directly on my mobile phone in Australia, 041 094 2230, or simply send me an email to [email protected].

 

Download the free checklist in the description. Subscribe and hit the bell so you don’t miss the next video. And if you have a question, leave it in the comments, because I might answer it in a future video. This video is general information only, so please speak with your father’s doctor about your specific situation. My name is Patrik Hutzel from 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), Home CPAP (Continuous Positive Airway Pressure) (https://intensivecareathome.com/quality-life-nursing-services-adults-children-requiring-non-invasive-mask-ventilation-cpap-bipap-andor-high-flow-oxygen-therapy/) ventilation without tracheostomy
• Tracheostomy care without ventilation
• Home TPN (https://intensivecareathome.com/tpntotal-parenteral-nutrition-administration-picc-line-central-line-care-community/)
• 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 (http://intensivecarehotline.com/central-venous-lines/), PICC (Peripherally Inserted Central Catheter) line, Hickman’s line as well as port management at home
• Nasogastric tube, nasojejunostomy tube, PEG (Percutaneous Endoscopic Gastrostomy) (https://intensivecarehotline.com/your-loved-ones-treatment/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.