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Education and Care Gaps in Tracheostomy Management: A Multi-Stakeholder Survey, Access Challenges

In this multi-part video series, I’m “Addressing Education and Care Gaps in Tracheostomy Management: Insights from a Multi-Stakeholder Global Survey” from the Global Tracheostomy Collaborative that they have published on their website a few or a couple of months ago.

It’s a very long survey. It’s a very good survey even though it’s not very solution focused, which is why I am critiquing this survey, but also have solutions because we have the solutions here at intensivecareathome.com. You can find more information, of course, at intensivecareathome.com.

So, I’ve broken down every single section of this survey so far. Today, I want to continue that critique of the survey with challenges with access and affordability of tracheostomy care. I will also link to any of the other sections that I’ve done so far.

By the way, my name is Patrik Hutzel from intensivecareathome.com. So today, we’re going to look as part of the survey, challenges with access and affordability of tracheostomy care.

The survey says,

The challenges related to access to and affordability of tracheostomy care were categorized by role, highlighting the diverse perspectives of administrators, family members, patients, and healthcare professionals.

So, what does access to care look like?

The most frequently reported concern was access for underserved communities, with speech-language pathologists and respiratory therapists identifying this as a major challenge.

I’ll be very curious to hear what will be labelled as undeserved communities.

Other notable issues included patient and family financial strain, reported most often by speech-language pathologists and respiratory therapists. Transportation difficulties and distance to travel for were also significant barriers, with speech-language pathologists and nurses highlighting these challenges, accounting for 33–34% of respondents in both cases.

Twenty-four respondents (14%) provided free-text comments on access-related concerns, which emphasized the complex interplay between tracheostomy care access and social determinants of health, financial resources, transitional care complexities, and community involvement. Commonly mentioned themes were barriers related to health insurance, coordination of care, workforce availability, and community investment. Respondents cited underinsurance, language barriers, a lack of educational materials in multiple languages, systemic healthcare disparities, misalignment of care pathways, limited access to trained professionals in community settings, and a shortage of specialists willing to provide long-term tracheostomy care.

I disagree with most of this because underinsurance is never a problem. Otherwise, we would not be in business. So, what I mean by that is, as long as the business proposal is correct and the care proposal is correct, there’s no issue with insurance because it has to be positioned correctly. We are freeing up an ICU bed and we’re cutting the cost of an ICU bed by 50%. So therefore, it is a win-win situation for anyone who’s paying for an ICU bed.

Lack of educational materials in multiple languages. We can’t provide that, but we have education for our nurses that work with our clients.

Systemic healthcare disparities. Again, we don’t advocate for that, of course. All of our clients have care regardless of their social status because if we cut the cost of an ICU bed by 50%, whoever’s paying for the ICU bed has an interest in cutting the cost of the ICU bed by 50%.

Misalignment of care pathways. Once again, that all comes down to having professional support in the community. It all comes down to getting patients home in the community with tracheostomies, with the right trained professionals, which can only be and exclusively critical care trained nurses that have a minimum of 2 years critical care nursing experience, and ideally have a postgraduate critical care nursing qualification because that is actually evidence-based. Once again, this survey does not speak once about evidence.

So, what does evidence-based mean when it comes to community care and ventilation and tracheostomy? You’ll find the Mechanical Home Ventilation Guidelines  on our website at intensivecareathome.com. You will find there that it’s evidence that only and exclusively critical care trained nurses with the minimum 2 years critical care nursing experience, ideally with a critical care nursing qualification are safe to look after ventilation and tracheostomy adults and children in the community.

In regards to the shortage of specialists willing to provide long-term tracheostomy care, again, I disagree there. There’s enough nurses out there and doctors as well that want to work in the community, just have to work for the right organization with the right care structure, which once again, is what we are doing here at intensivecareathome.com.

Other concerns included inadequate discharge education, insufficient home support post-discharge…

Again, that’s where we come in. We have sufficient home support post-discharge.

…inappropriate discharge placements,

Yes, that happens if you send support workers, for example, registered nurses that have no ICU experience, that would be inappropriate.

…limited funding for community-based tracheostomy services, and shortages of private-duty nurses and respiratory therapists.  Respondents also noted inconsistencies in care standards between hospitals and community settings…

That is if you don’t have the right provider. Once again, we have a hospital type service that we bring at home. So therefore, our care standards at home are very high. As a matter of fact, I argue we are the only organization that brings standards into the community when it comes to ventilation and tracheostomy.

The survey continues,

…and limited access to supplies from durable medical equipment providers.

Again, I argue that can all be taken care of and is taken care of.

Family-related stressors, such as parental work commitments and health issues affecting other family members, were also identified as factors complicating access to tracheostomy care.

So, 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
• 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 instead of staying 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’re a NDIS (National Disability Insurance Scheme) approved service provider all around Australia, TAC (Transport Accident Commission) and WorkSafe in Victoria, and 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 currently 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 level of accreditation 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, 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’re living in an ICU, I’ll give you another tangible and real-world example today.

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 ventilated and tracheostomy client. That is dangerous and it’s negligent. Having support workers looking after a client at home on a ventilator with a tracheostomy. It’s like flying the airplane with the 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 risk of dying if they don’t have a team of 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 a home care environment in the community?

So, this client found out about us eventually and the ICU that he went back to all the time 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 intensive care nurses, 24 hours a day. He never ever went back into ICU ever again, as long as we 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. The same is applicable for those stuck in an ICU, similar to our case study that I’ve 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 Level 2 and Level 3 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 in Victoria.

If you’re a 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’re looking for a career change, we’re currently hiring for jobs for critical care nurses in Melbourne, Sydney, Brisbane, in Albury, Wodonga, Bendigo, in Geelong, and 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, and 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 are 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 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. or 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.