My name is Patrik Hutzel from intensivecareathome.com. I have been working in intensive care nursing and critical care nursing for over 25 years, and I am the founder of intensivecareathome.com. We are Australia’s only third-party accredited provider of specialist Intensive Care at Home nursing, and we have been operating since 2012.

 

With Intensive Care at Home, we provide tailor-made solutions for long-term ventilated adults and children with tracheostomies at home, tailor-made solutions for long-term ventilated adults and children on BiPAP (Bilevel Positive Airway Pressure) and CPAP (Continuous Positive Airway Pressure), which is also known as non-invasive ventilation, tailor-made solutions for tracheostomy care at home without ventilation, home ventilation weaning management, cough assist management at home, home TPN (Total Parenteral Nutrition), home intravenous (IV) fluids, home IV antibiotics, home IV potassium, home IV magnesium infusions, central line, PICC (Peripherally Inserted Central Catheter) line, Hickman’s line, port management at home, indwelling urinary catheter (IDC), suprapubic catheter (SPC) management at home, PEG (Percutaneous Endoscopic Gastrostomy) tube, PEJ (Percutaneous Endoscopic Jejunostomy) tube, nasogastric tube, nasojejunostomy tube management at home, as well as palliative care services at home.

 

Recently I received a phone call from a nurse practitioner, Anthony, who is working in the community in rural Queensland. He had been asked by the respiratory team at Rockhampton Hospital in northern Queensland to explore home care options for an 85-year-old gentleman with severe chronic obstructive pulmonary disease (COPD) who had developed type 2 respiratory failure during his hospital stay. The team was considering discharging this man into the community on high flow oxygen. The call was a great example of the real-world conversations that happen every day around hospital discharge for complex respiratory patients, and it highlights exactly the kind of support that Intensive Care at Home is uniquely positioned to provide.

 

In today’s video, I want to walk you through that conversation, explain the key clinical and funding considerations for this kind of patient, and show what home-based intensive care nursing can realistically look like even in regional areas such as remote Queensland.

 

The patient had severe COPD and type 2 respiratory failure, which means he was retaining carbon dioxide (CO2). He was also on high flow nasal prong oxygen. The nurse practitioner who called me about this 85-year-old man living in Rockhampton, Queensland confirmed he had been admitted to Rockhampton Hospital initially for a urinary tract infection (UTI), but had subsequently developed a significant respiratory event. He had a background of severe COPD and was now classified as type 2 respiratory failure, meaning he was retaining CO2 at the time of the call. He had been in hospital for approximately 20 days and was located on the medical ward at Rockhampton Hospital. The Brisbane-based respiratory and thoracic team was providing remote clinical support, as Rockhampton does not have its own full respiratory and thoracic service. The team was looking at discharging him into the community on high flow nasal oxygen and non-invasive ventilation, and the nurse practitioner had been asked to explore whether this was feasible, what options existed, and whether Intensive Care at Home could be involved.

 

Let’s also quickly look at what does high flow oxygen versus BIPAP or CPAP actually mean.

 

High flow nasal oxygen delivers heated and humidified oxygen at flows of up to 60 litres per minute, with adjustable fraction of inspired oxygen (FiO2). It provides a small degree of positive end-expiratory pressure (PEEP), but this is minimal compared to non-invasive ventilation such as CPAP or BiPAP. For a patient with CO2 retention, high flow nasal prongs alone is often insufficient for long-term respiratory management at home, specifically in type 2 respiratory failure.

Can Intensive Care at Home support high flow oxygen, BiPAP, CPAP, and tracheostomy care in regional Queensland? The short answer is yes. At Intensive Care at Home, we regularly care for patients in their homes on high flow nasal oxygen, non-invasive ventilation such as BiPAP and CPAP, and also on invasive mechanical ventilation via tracheostomy. Our service operates all around Australia in all major capital cities as well as in all regional and rural areas, including Queensland and the Rockhampton area. We employ around 150 critical care registered nurses. Rockhampton is well within our operational reach, logistics, staffing, and clinical capability are all achievable for this type of patient.

Accreditation matters for your loved one, and accreditation also matters if you are a health professional, hospital executive, or doctor watching this. At Intensive Care at Home, we are not just naming our service this way, we also have third-party accreditation for Intensive Care at Home. In 2026, we are the only Intensive Care at Home nursing provider in Australia that is third-party accredited for Intensive Care at Home nursing, which includes ISO 9001:2015 as well as NDIS. There is no other provider in the country that has achieved third-party accreditation for Intensive Care at Home nursing. There is no other provider that has developed the know-how, the intellectual property, the policies and procedures for Intensive Care at Home nursing as we have. You can verify our accreditation status at intensivecareathome.com/accreditation_quality.

 

Let’s now continue looking at the CO2 retention issue. Is high flow oxygen really enough? During the call with the nurse practitioner, I raised a concern that I want to address in more detail here because it is clinically important. Type 2 respiratory failure involves CO2 retention, clinically known as hypercapnia. This is different from type 1 respiratory failure, which involves only low oxygen levels without CO2 retention. For patients with type 2 respiratory failure who are retaining CO2, high flow nasal oxygen alone is not always the right long-term solution. While high flow nasal oxygen does provide a small degree of PEEP, it is not comparable to CPAP or BiPAP in terms of its ability to support ventilation and reduce CO2 levels.

The more appropriate and evidence-based long-term respiratory support for severe COPD with CO2 retention is typically non-invasive ventilation, either CPAP or, more commonly, BiPAP. BiPAP provides inspiratory positive airway pressure (IPAP) in addition to expiratory positive airway pressure (EPAP), which directly assists the work of breathing and helps wash out CO2. Our evidence-based, third-party accredited approach to home mechanical ventilation is outlined in detail in our evidence-based Mechanical Home Ventilation Guidelines, which you can read on our website at www.intensivecareathome.com.

 

So, let’s also look at the importance of clinical considerations for CO2 retaining COPD patients. For patients with severe COPD and CO2 retention and type 2 respiratory failure being considered for home discharge, the clinical team should assess whether high flow nasal oxygen alone is sufficient, or whether initiation of non-invasive ventilation such as BiPAP prior to discharge would provide safer and more sustainable long-term respiratory management.

 

Let’s also look at funding options for an 85-year-old gentleman on high flow oxygen at home. This where the call with the nurse practitioner got particularly practical and it is a question we navigate every day.

 

For an 85-year-old gentleman, the National Disability Insurance Scheme (NDIS) is not an option, unfortunately. The NDIS has a strict age cut-off of 65, so that avenue is not available here. Funding pathways I suggested for Anthony, the nurse practitioner, to explore were:

• Private health insurance – depending on his level of cover, some home nursing services may be partially or fully covered
• Aged care funding and aged care assessment may unlock home care packages or Commonwealth Home Support Program (CHSP) funding; however, these packages are generally not resourced for the level of nursing intensity required for high flow nasal oxygen, BiPAP, CPAP, or tracheostomy ventilation at home
• Hospital in the Home – I asked whether Rockhampton Hospital operates a Hospital in the Home service; the nurse practitioner confirmed they do, but that it would be outside their scope for this level of care; this is actually a very common scenario and this is where we come in, because we are able to subcontract to a Hospital in the Home service, bringing the Hospital in the Home acuity to the next level and ensuring that more patients can go home safely, predictably, and permanently, because Hospital in the Home services generally speaking lacks the provision. Our specialist nursing capability that we have but hospital-based HT programs do not have and lack.
• Department of Veterans’ Affairs (DVA) – I asked Anthony the nurse practitioner whether this gentleman had any DVA entitlements; he confirmed this was not applicable in this case

It is worth noting that funding for high acuity home nursing, particularly for patients requiring respiratory support, remains one of the most significant systemic gaps in Australia’s healthcare system. This is an area where we continue to advocate for change at a policy level, but we have been very successful otherwise we would not exist. Everything is negotiable, and that is where we come in to help you negotiate with private health insurance, hospitals, departments of health, NDIS, DVA, and so forth.

 

Here is a tip for families and health professionals, including hospital chief executive officers (CEOs) and hospital administrators. If your loved one or a patient is being discharged from hospital on high flow oxygen, CPAP, or BiPAP, with or without a tracheostomy, please contact us to discuss funding options before assuming that home care is not possible because of funding constraints. They are often only perceived funding constraints, not real ones. There are often far more pathways available than the hospital team is aware of.

 

Let’s now also look at palliative care at home, another option worth knowing about.

 

Towards the end of the call, Anthony, the nurse practitioner raised the topic of palliative care. I want to address this clearly. Intensive Care at Home also provides specialist palliative care nursing at home. For a patient like this gentleman, 85 years old, with severe COPD, multiple comorbidities, and a significant respiratory event, palliative care may be a very reasonable and compassionate option to explore alongside the more active treatment pathways. Our nurses are trained and experienced in managing complex symptom control, including for patients with end-stage respiratory disease. Palliative care at home, delivered by specialist critical care registered nurses, allows patients to remain in their own environment with dignity and comfort. It is not about giving up, it is about giving patients and families control over how end-of-life care is experienced and delivered.

 

So what does a hospital in the home subcontracting model looks like? One of the more practical solutions I suggested to Anthony was the possibility of Intensive Care at Home subcontracting to Rockhampton Hospital’s, Hospital in the Home service. This is a model we have successfully implemented in other hospitals. The hospital retains clinical governance and billing through Medicare, while Intensive Care at Home provides the specialist nursing staff who actually deliver the care in the patient’s home. This works particularly well when the patient’s clinical complexity is beyond what standard Hospital in the Home nurses can safely manage, because most Hospital in the Home services only employ general registered nurses, whereas we employ specialist critical care trained nurses. This means we can safely take on higher acuity patients in the community. Health services generally lack the critical care nursing capacity and workforce for this type of patient, particularly when the patient lives in a location where the hospital would struggle to staff the case directly.

 

If you are a hospital discharge planner, ICU social worker, ICU doctor, ICU nurse, nurse practitioner, Hospital in the Home coordinator, director of nursing, hospital CEO, medical director, or respiratory team member, and you want to explore a subcontracting arrangement for a complex patient at your hospital, reach out to us directly.

 

What this call with Anthony also tells us about the gap in Australia’s healthcare system. Anthony’s call was not unusual, it reflects a gap that exists right across Australia. There is a lack of awareness among health professionals and families that genuinely specialist, third-party accredited, home-based intensive care nursing is available, is safe, and is clinically credible. It keeps patients at home permanently and predictably, and more importantly, cuts the cost of a hospital bed by as much as 50% while freeing up highly sought-after hospital beds, mainly intensive care beds. Intensive Care at Home has been bridging this gap since 2012. We are the only service in Australia that is third-party accredited specifically for Intensive Care at Home nursing. We operate under strict ISO 9001:2015 standards as well as NDIS Quality and Safety Commission standards. Our nurses are critical care registered nurses with ICU nursing backgrounds, not generalist community nurses.

 

If you are a health professional exploring options for a complex discharge patient, or a family member of someone in the ICU or on a respiratory ward who needs information about home-based intensive care, please go to intensivecareathome.com and call us on one of the numbers on the top of our website, or send an email to [email protected].

Here are the most frequently asked questions we receive in relation to a situation like the one described today, an 85-year-old man on high flow nasal prongs for COPD.

 

Can you go home on high flow oxygen? 

Yes, it is absolutely possible for patients to be discharged home on high flow nasal oxygen, and Intensive Care at Home specifically provides exactly this type of specialist nursing care. However, it is important to assess whether high flow oxygen is clinically sufficient for your specific situation. For patients with type 2 respiratory failure, meaning CO2 retention, also known as hypercapnia, high flow oxygen alone may not be adequate long-term, and non-invasive ventilation such as BiPAP or CPAP is often more appropriate. The decision should be made with your respiratory specialist, ideally before discharge.

 

What is the difference between high flow oxygen and BiPAP for COPD? 

High flow nasal oxygen delivers heated, humidified oxygen at high flow rates and provides a small amount of positive airway pressure, also known as PEEP. BiPAP, on the other hand, actively assists each breath with inspiratory pressure support, which directly reduces the work of breathing and helps the body eliminate CO2 (carbon dioxide). For patients with severe COPD who are retaining CO2, type 2 respiratory failure, BiPAP is generally the evidence-based treatment of choice. See our evidence-based Mechanical Home Ventilation Guidelines at intensivecareathome.com for more detail.

 

What funding is available for home care nursing for patients over 65 in Australia? 

For patients over 65, unfortunately, the NDIS is not available, it has a strict age cut-off at 65. Funding options to explore include private health insurance depending on your level of cover, aged care home care packages through an Aged Care Assessment Team (ACAT) assessment, the Commonwealth Home Support Program (CHSP), DVA funding for eligible veterans, Hospital in the Home through the discharging hospital, Department of Health funding, and privately funded patients. It is always worth advocating, because the funding is usually there. The funding is not an issue. It just depends where it is coming from. Funding could also come from the hospital directly, because the reality is, hospitals need beds, and that will cost them some money to get patients home into the community. But hospitals also need to partner with their consumers and one way to partner with their consumers is to pay attention to where patients and families want to be, which is in the community and we provide a direct pathway into the community so that patient can stay home safely, permanently and predictably.

 

It is also worth noting that most aged care funding packages are not resourced for the level of nursing intensity required for patients on high flow oxygen, BiPAP, CPAP, or tracheostomy care at home. Please contact us at intensivecareathome.com to discuss the full range of options for your specific situation.

 

Does Intensive Care at Home cover regional and rural Queensland or any regional or rural areas in Australia? 

Yes, Intensive Care at Home operates across all Australian states and territories, all major capital cities, and all regional and rural areas. We are able to staff and support patients in regional areas, including Rockhampton and surrounding central Queensland. If you are unsure whether we can service your location, please call us on one of the numbers on the top of our website or send an email to [email protected].

 

Can Intensive Care at Home subcontract to a hospital service like Hospital in the Home? 

Yes, absolutely. This is a model we have successfully implemented with hospitals where the health service lacks the clinical capability or specialist nursing workforce to manage a complex discharged patient. We supply the critical care registered nurses, manage the clinical nursing governance, and the hospital retains the case for billing purposes. If you are a Hospital in the Home coordinator, discharge planner, hospital administrator, medical director, director of nursing, bed manager, or operations manager and you want to explore this arrangement, contact us directly at intensivecareathome.com.

 

Is Intensive Care at Home accredited? 

Yes. Intensive Care at Home is the only Intensive Care at Home nursing service in Australia that is third-party accredited specifically for Intensive Care at Home nursing. We have been providing Intensive Care at Home since 2012 and we are the only provider that is third-party accredited. We are the only provider that has developed the policies and procedures and the intellectual property to make it safe. We are employing hundreds of years of intensive care nursing experience combined in the community. No other service provider in Australia brings that level of skill into the community when it comes to Intensive Care at Home nursing. You can view our accreditation details at intensivecareathome.com/accreditation_quality.

 

Can palliative care be provided at home for patients with severe COPD? 

Yes, absolutely. Intensive Care at Home provides specialist palliative care nursing in the home for patients with complex conditions, including end-stage COPD and other respiratory diseases. Our critical care registered nurses are experienced in managing complex symptom control, pain management, and end-of-life care in the home environment. Palliative care at home allows patients and families to remain in a familiar, comfortable setting with dignity and family around them. It can be the right choice when active treatment is no longer appropriate or desired.

 

What qualifications do our nurses have at Intensive Care at Home? 

All of our nurses at Intensive Care at Home are critical care registered nurses, meaning they have a minimum of two years critical care nursing experience in hospitals. Most of them have postgraduate critical care nursing qualifications. No other provider brings a higher skill level and a higher experience level in the community than we do on a nursing level. Our nurses are critical care nurses, not general community or aged care nurses. We are very specialized. We are bringing intensive care into the home. This specialist clinical background is what makes all the difference and makes it possible for us to safely manage patients at home on high flow oxygen, BiPAP, CPAP, invasive mechanical ventilation, tracheostomy care, and other complex interventions that would otherwise require ongoing hospitalization or even ICU stays.

 

How long can a patient with severe COPD stay on high flow oxygen at home?

There is no fixed time limit. The goal of home-based care is to support the patient’s respiratory needs in the most comfortable and least restrictive setting possible. For some patients, high flow oxygen at home is a long-term management strategy. For others, the clinical picture may evolve and require upgrading to non-invasive ventilation. Our nurses monitor patients continuously and work closely with the treating respiratory team to ensure the care plan remains appropriate over time.

 

What should I do if my loved one is being discharged from hospital on oxygen or ventilation and I am not sure the plan is safe? 

This is exactly the situation we exist for at Intensive Care at Home. If you have a loved one in the hospital, ICU, or being discharged against your wishes and you are concerned about the safety or appropriateness of the plan, please contact us at intensivecareathome.com today. Because that would be unsafe. Hospitals often need to push patients out, and you do not want your loved one to be pushed out unsafely. If your loved one is being sent home on high flow nasal prongs, BiPAP, CPAP, or with a tracheostomy, it’s a death sentence. I’ve spoken about this extensively on my channel here. I’m not going to break it down any further. If they want to discharge your loved one on any of these high flow nasal prongs, BIPAP, CPAP, tracheostomy, you need to put a stop to it and we can help you.

We can help you put a stop to it, make it safe, and get the funding. Reach out to us 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.