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 long-term ventilated adults and children on non-invasive ventilation such as BiPAP (Bilevel Positive Airway Pressure) and CPAP (Continuous Positive Airway Pressure). We provide tailor-made solutions for adults and children with tracheostomy without ventilation, home ventilation weaning, home cough assist management, home TPN (Total Parenteral Nutrition), home IV fluids, home IV antibiotics, home IV (intravenous) potassium, home IV magnesium infusions and any electrolyte infusions at home, including central line, PICC (Peripherally Inserted Central Catheter) line, Hickman’s line, as well as port management at home. We also provide nasogastric tube, nasojejunostomy tube care at home, PEG (Percutaneous Endoscopic Gastrostomy) tube, PEJ (Percutaneous Endoscopic Jejunostomy) tube management at home, as well as IDC (Indwelling Catheter) and SPC (Suprapubic Catheter) management at home, as well as palliative care management at home.

 

Before we get into today’s topic, I want to acknowledge Debbie, who wrote in with this question:

 

“Hi Patrik,

 

I’m trying to help bring my father home from the hospital. He is currently on 60% FiO2 and has a tracheostomy placed while recovering from several hospital-acquired pneumonias. The hospital says his oxygen needs are too high for him to go home or even to a rehab facility and they don’t know if he will improve. He is otherwise able to move around and is alert and oriented. There has to be something else we can do besides keeping him there. — Debbie”

 

Debbie, thank you for writing in. This is one of the most common situations I hear about from families — and one of the most frustrating — because the hospital’s position that your father cannot leave simply because he is on 60% oxygen is not necessarily clinically correct. There are real, evidence-based, safe alternatives. And I want to walk you through exactly what they are.

 

What Does 60% FiO2 Actually Mean?

First, let’s make sure we understand what we are talking about. FiO2 stands for Fraction of Inspired Oxygen. Room air is 21% FiO2. When we say someone is on 60% FiO2, we mean they are receiving a controlled oxygen delivery where 60% of what they breathe is oxygen.

 

Now here is the critical clinical point that hospitals often fail to explain to families:

The significance of 60% FiO2 depends entirely on how the oxygen is being delivered and what the patient’s clinical picture looks like.

 

A patient on 60% FiO2 via a high-flow tracheostomy mask — particularly one who is alert, oriented, and able to move around — is a fundamentally different clinical situation from a patient on 60% FiO2 who is sedated, intubated, and critically unstable on a mechanical ventilator in ICU.

 

Debbie’s father is alert. He is mobile. He has a tracheostomy in situ. Those are enormously positive clinical signs. The hospital is looking at the oxygen percentage in isolation and drawing a conclusion that does not necessarily follow from the evidence.

 

Why Hospital-Acquired Pneumonias Are Actually an Argument For Getting Him Home

Debbie mentions that her father has had several hospital-acquired pneumonias — also known as nosocomial pneumonias. This is a critically important detail, and it cuts directly against the hospital’s position that staying in hospital is the safe option.

 

Hospital-acquired pneumonias are infections that patients develop as a direct result of being in hospital. They are caused by hospital-based bacteria — organisms like Pseudomonas aeruginosa, Acinetobacter, Klebsiella, and MRSA (Methicillin-Resistant Staphylococcus aureus) — that are far more antibiotic-resistant than community bacteria and far more dangerous.

 

Every day that Debbie’s father remains in hospital, he is being exposed to the same environment that gave him those pneumonias in the first place.

The hospital is effectively saying: he is too sick to leave because of his oxygen needs. But those oxygen needs exist largely because of infections he acquired in hospital. The solution they are offering — keep him in hospital — is also the source of the problem. This is a cycle that many families never have explained to them, and it is one of the most important arguments for transitioning complex patients home safely with the right clinical support.

 

At home, the bacterial environment is completely different. There are no multi-resistant hospital/ICU organisms circulating. The risk of further nosocomial pneumonia drops dramatically once a patient is out of the hospital environment with proper clinical care in place.

 

What Are the Evidence-Based Options for High Oxygen Needs at Home?

This is where the evidence becomes very important. At Intensive Care at Home, we follow the evidence-based Mechanical Home Ventilation Guidelines, which provide a framework for safely transitioning complex patients — including those with high oxygen requirements — from hospital to home.

 

There are several oxygen delivery options that can be safely delivered in the home setting for a patient with a tracheostomy:

 

1. Tracheostomy Collar / T-Piece with Supplemental Oxygen

For adults and children with a tracheostomy who is breathing spontaneously, oxygen can be delivered directly via a tracheostomy mask or T-piece connected to a high-flow oxygen source. This is commonly used in hospital wards and can be replicated at home with the appropriate equipment and nursing oversight.

 

2. High-Flow Nasal Cannula (HFNC) via Tracheostomy

High-flow oxygen therapy can be adapted for use through a tracheostomy in adults and children who require higher FiO2 levels. This provides both humidified oxygen and a degree of positive airway pressure support, which assists with oxygenation and reduces the work of breathing.

 

3. Non-Invasive Ventilation (BiPAP) with Supplemental Oxygen

In some adults and children adding BiPAP (Bilevel Positive Airway Pressure) support — even at relatively modest pressures — can allow the FiO2 requirement to come down significantly by improving alveolar recruitment and gas exchange. This is a well-established strategy in managing patients with persistent oxygen requirements after pneumonia.

 

4. Home Mechanical Ventilation via Tracheostomy

In adults and children who are not weaning from ventilator support, long-term home mechanical ventilation via tracheostomy is a well-established and extensively documented clinical pathway. Intensive Care at Home has been delivering this third part accredited nursing service in Australia since 2012.

The key point is this: a 60% FiO2 requirement does not automatically disqualify a patient from going home. It requires the right clinical assessment, the right equipment, and critically — the right nursing expertise.

 

Why the Hospital Saying “We Don’t Know If He Will Improve” Should Not Keep Him There

This is one of the most common and most unhelpful things hospitals say to families. “We don’t know if he will improve.” That statement is used — sometimes unconsciously — to justify ongoing hospitalization indefinitely.

 

But consider this: if the hospital does not know whether he will improve, then there is no clinical basis for saying he must remain in hospital waiting for improvement that may or may not come. Uncertainty cuts both ways. And the evidence is clear that patients in their own home environment, with proper clinical support, often do better — not worse — than patients who remain in hospital.

 

Recovery from repeated pneumonias, respiratory muscle fatigue, and the deconditioning effects of prolonged hospitalization is frequently more successful in the home environment, where patients sleep better, eat better, engage more meaningfully with family, and are not continually re-exposed to hospital organisms.

 

What Does Intensive Care at Home Deliver for Patients Like Debbie’s Father?

Intensive Care at Home is Australia’s only Intensive Care at Home nursing service that is third-party accredited specifically for Intensive Care at Home nursing. You can verify this at intensivecareathome.com/accreditationquality. We hold ISO 9001:2015 certification and NDIS Quality and Safety Commission accreditation, audited by BSI Group with zero non-conformances. No other home care provider in Australia has achieved this standard for intensive care nursing.

For a patient like Debbie’s father — tracheostomy in situ, requiring supplemental oxygen, recovering from hospital-acquired pneumonias, alert and mobile — here is what we provide:

• 24/7 Critical Care Registered Nurses with ICU-level tracheostomy management experience
• Oxygen therapy management and titration in the home — including high-flow delivery via tracheostomy collar
• Continuous monitoring of respiratory status, oxygen saturations, and clinical observations
• Secretion management and tracheostomy suctioning
• Liaison with respiratory physicians and intensivists for ongoing clinical oversight
• Ventilator weaning in the home if indicated as the patient improves
• Infection prevention protocols — dramatically reducing re-exposure to hospital/ ICU organisms
• Clinical documentation equivalent to hospital-standard records

 

We operate all around Australia, in all metropolitan cities, in all regional and remote areas, basically in all states and territories. We employ hundreds of years of Care Registered Nursing experience combined with a minimum of 24 months’ ICU experience but most of our ICU nurses rather have 8-10 years ICU experience. We have delivered millions of hours of intensive care nursing at home since 2012. No other provider in Australia has delivered more hours safely than we have.

 

We are not a general home care provider. We are an ICU-level nursing service that operates in the home, providing a genuine alternative to a Long-Term stay in Intensive Care. That distinction matters enormously for patients like Debbie’s father.

 

What Should Debbie Do Right Now?

If you are in the same situation as Debbie, here are the concrete steps I recommend:

Step 1: Request a formal respiratory review.

Ask the treating team for a formal review from a respiratory physician — not just the ICU or ward team — specifically focused on the question of home eligibility. Ask for a documented clinical opinion on whether the 60% FiO2 requirement can be managed outside of hospital with appropriate nursing and equipment support.

 

Step 2: Ask the hospital to contact Intensive Care at Home directly.

We work directly with hospital discharge teams, ICU consultants, and respiratory physicians. We can provide a clinical capability overview that allows the hospital team to make an informed decision about whether home discharge is achievable. Contact us at intensivecareathome.com or call us on 1300 921 536 or email us to [email protected]

 

Step 3: Understand your rights as a patient and family.

Families have the right to seek second opinions. Patients cannot be compelled to remain in hospital or ICU indefinitely against their wishes if they have decision-making capacity. If the hospital is unable or unwilling to facilitate a safe discharge pathway, you have the right to seek that pathway independently.

 

Step 4: Contact us for a consultation.

At Intensive Care Hotline — our sister service at intensivecarehotline.com — we provide consulting and advocacy for families in exactly this situation. We can help you understand the clinical picture, ask the right questions, and advocate for a discharge pathway that is in your father’s best interests.

 

The Bottom Line

Debbie, your instinct is right. Keeping your father in hospital indefinitely because of a 60% FiO2 requirement — when he is alert, oriented, and mobile — is not the only option. The hospital’s uncertainty about whether he will improve is not a reason to keep him where he acquired the pneumonias that created this situation in the first place.

 

There are evidence-based, clinically safe, accredited pathways to bring him home with the right nursing support. Intensive Care at Home has done this for hundreds of families across Australia.

 

If you want to know more about how we can help, visit us at intensivecareathome.com or call 1300 921 536. We are here to help.

 

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) ventilation without tracheostomy
• Tracheostomy care without ventilation
• Home TPN 
• 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.