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 BiPAP (Bilevel Positive Airway Pressure), CPAP (Continuous Positive Airway Pressure) or non-invasive ventilation, where 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 (Intravenous) potassium, home IV magnesium, home IV fluids and home IV antibiotic infusions, central line, PICC (Peripherally Inserted Central Catheter) line, Hickman’s line, as well as port management at home, PEG (Percutaneous Endoscopic Gastrostomy) tube, nasogastric tube, nasojejunostomy tube, IDC (Indwelling Catheter), SPC (Suprapubic Catheter) management at home, as well as palliative care services at home.

 

Today’s video is inspired by a real phone call that I had with a potential client, and it’s about one of the most important questions families come to us with every single day.

 

It is inspired by a real phone call that I had with a gentleman called Peter the other day. Peter called me about his 86-year-old mom, who has been in the ICU since around December 20th last year. At the time of this recording, today is the 14th of February. His mom has a complex medical history. She had a series of small strokes. She has metastatic lung cancer that has been held in check by targeted gene therapy medication. She suffered a larger stroke that left her with aphasia and some weakness. She was admitted to the ICU because her oxygen levels dropped very suddenly and very significantly.

 

When she was first admitted, the ICU team was extremely pessimistic. They called Peter and his wife down to say goodbye. Peter told me and I found this very moving, that she then started to recover. She was placed on BiPAP. She came off BiPAP onto high-flow oxygen over the Christmas period, and she was off the mask for 36 to 40 hours at one point because she simply didn’t want it back on. Since then, she has been primarily on BiPAP. She has had some heart issues, atrial fibrillation, blood pressure instability and she has been on TPN, also known as total parenteral nutrition or intravenous nutrition, for her nutrition since late December. The lung inflammation that the ICU team told the family would never resolve did resolve, Peter told me and yet the ICU team has continued to push for hospice care, end-of-life care, or what they call euphemistically comfort care. Peter and his father had to engage a patient advocate just to get the medical team to back off.

 

Here’s what struck me the most about this conversation. Peter told me that just a few days before our call, his mom’s oxygen levels dropped, and the doctor asked her if she wanted the mask back on. His father actually told her, “If you don’t want to fight anymore, it’s OK,” and she said, “No, give me back the mask.” She’s still making her own decisions. She’s still in the driver’s seat, and she has even said, unprompted, that she wants to go home. And Peter asked me, is any of this possible? Can she come home with Intensive Care at Home? Can she be managed on BiPAP at home with Intensive Care at Home? My answer was, of course, yes. If she’s hemodynamically stable, if her blood pressure is not too far up and down, BiPAP can absolutely be managed at home. TPN can absolutely be managed at home, whether it’s with a central line, a PICC line, a Hickman’s line, or a port. These are services we provide every single day at Intensive Care at Home.

 

I want to use Peter’s story as the foundation for today’s video because this situation represents something I see multiple times a week, a family being told there is no hope, being pushed towards hospice and end-of-life care, when in reality their loved one is still very much alive, still communicating, still making decisions, and still asking to come home with Intensive Care at Home. The question is, what are the actual steps to make that happen?

 

Let me walk you through them. But before I do, it also beckons the question, why is the intensive care team not talking to a patient directly who is compos mentis, who has their own mind? Why are they not asking the patient directly what they want? It’s a bit cowardly, isn’t it, not having the conversation directly with a patient who is alert.

 

This is not just my opinion. This is based on our evidence-based Mechanical Home Ventilation Guidelines, which you can find on our website at intensivecareathome.com. These guidelines are drawn from decades of international and national Intensive Care at Home services, mainly in Germany and in Australia, because they are based on evidence-based practice in those countries that a patient like Peter’s mom can go home with 24-hour intensive care nurses and replicate the ICU in the home.

 

Step 1: Understand the Two Types of Home Ventilation

When we talk about mechanical ventilation at home, we are talking about two main categories, and each one has its own process, its own requirements, and its own pathway home.

 

In Peter’s mom’s case, she is on non-invasive ventilation — BiPAP — which, as I told Peter on our call, is absolutely manageable at home.

 

Non-invasive ventilation means your loved one is being ventilated through a mask — either a nasal mask, a full face mask, or a mouthpiece — without a tracheostomy. This is the most common form of home ventilation, and many conditions only require ventilation at night or part of the day. Conditions where we commonly see non-invasive ventilation at home include COPD (Chronic Obstructive Pulmonary Disease), muscular dystrophy, spinal cord injuries, motor neuron disease, kyphoscoliosis, cerebral palsy, Rett syndrome, and many more.

 

The second form of ventilation at home is invasive ventilation, also known as tracheostomy ventilation. Invasive ventilation means your loved one has a tracheostomy, a surgical opening in the neck and is connected to a ventilator through that tracheostomy. This is what we call a higher level of care, and it requires even more specialized 24/7 intensive care nursing support at home.

 

According to our evidence-based Mechanical Home Ventilation Guidelines, invasive ventilation with a tracheostomy, as well as BiPAP or CPAP non-invasive ventilation at home, requires 24/7 intensive care nurses at home. This has been used successfully for decades at home in a large number of adults and children.

 

The key is that it must be done properly and safely with the right team, 24-hour intensive care nurses at home, the right equipment, the right planning, and the right third-party accreditation, which we have for Intensive Care at Home.

 

Step 2: Make Sure the Underlying Condition or Illness Is Stable

This is absolutely crucial and is the number one prerequisite for getting your loved one home. Before anyone can be safely discharged home on a ventilator — whether invasive or non-invasive — the underlying illness or condition needs to be stable.

 

In Peter’s mom’s case, she has now plateaued. The lung inflammation that the ICU team said would never go away has resolved. She is on stable BiPAP settings. Her kidneys are working, and the primary concerns are her atrial fibrillation and blood pressure, both of which, as I told Peter can be monitored and managed at home.

 

That is what stable enough for discharge looks like in practice. It doesn’t mean perfect. It means manageable.

 

In practice, this means no acute infections that require hospital-level treatment — most infections we can treat at home anyway, including antibiotics. Ventilator settings are established and not frequently changed. There is no need for frequent ICU-level interventions. The medical team is confident the condition is manageable in the home environment with 24-hour intensive care nursing with Intensive Care at Home.

Your loved one doesn’t need to be fully recovered, but they do need to be at a stable baseline where home care is genuinely safe and appropriate.

 

Step 3: Get the Right Intensive Care Nursing Team in Place at Home

This is where I need to be very direct with you, because this is absolutely non-negotiable.

 

As our evidence-based Mechanical Home Ventilation Guidelines make very clear, mechanical home ventilation must only be provided by critical care trained nursing staff 24 hours a day. This is not optional. This is not something you can cut corners on.

 

Any nursing service that is looking after a ventilator-dependent adult or child in the community without critical care trained nurses is operating outside of evidence-based practice guidelines — full stop. People have died because of that, and I have evidence for everything I am saying here.

 

At Intensive Care at Home, we exclusively work with registered nurses with a minimum of two years intensive care or critical care nursing experience. We have lead nurses and managers on our team with a minimum of five years of intensive care nursing experience and postgraduate critical care nursing qualifications. Approximately 75% of our nurses have completed a postgraduate critical care nursing qualification, and we employ hundreds of years of critical care nursing experience combined.

 

No other provider in Australia can match the level of expertise that we are bringing into the community. No other provider in Australia in 2026 has achieved third-party accreditation for intensive care at home nursing. We have built the intellectual property. We have built the networks. We have built the know-how. Because this is what keeps your loved ones safe at home. This is what minimizes the risk of readmissions back to the ICU. This is what gives you, the family, genuine peace of mind.

 

Step 4: Secure All the Right Equipment Before Discharge

One of the most important steps in the discharge planning process and one that families often don’t realize is that all equipment must be sourced, installed, and tested before your loved one leaves the ICU.

 

For invasive tracheostomy ventilation, the minimum equipment required includes:

 

• The ventilator — and critically, if ventilation is required for more than 16 hours per day, a second identical backup ventilator must be provided external battery pack with at least 8 to 10 hours capacity if ventilation exceeds 16 hours per day
• Tracheostomy tubes and replacements, including inner cannulas
• High-performance suction devices with a flow rate greater than 25 liters per minute
• Humidification system — this is mandatory for tracheostomy ventilation; evidence shows that humidification at 37°C significantly reduces the risk of ventilator-associated pneumonia
• Handheld resuscitation bag with tracheostomy adapter
• Backup power supply — battery or generator
• Dressing and stoma care supplies
• Tracheostomy dilator

 

For non-invasive ventilation, BiPAP or CPAP, the minimum equipment includes:

 

• Pressure or volume-type ventilator- at least one reserve mask interface — every client must have a spare
• A spare backup ventilator
• Secretion management program or device — cough assist, breath stacking techniques
• Backup power supply
• Humidifier — strongly recommended for non-invasive ventilation such as BiPAP or CPAP to improve comfort and adherence

 

The equipment provider must also guarantee round-the-clock availability, with a technician available 24 hours a day if technical problems arise. Once again, this is all detailed in our evidence-based Mechanical Home Ventilation Guidelines.

 

Step 5: Establish Funding and Costs Before Discharge

This is something that absolutely must be sorted out before your loved one comes home. I say that not to stress you out. I say it because leaving this until the last minute is one of the most common reasons that discharges get delayed, sometimes by weeks or even months.

 

Home mechanical ventilation is 50% of the cost of an ICU bed, so any funding body will have a strong interest in cutting the cost by 50%. An ICU bed costs between $10,000 to $50,000 $5,000 to $10,000 per bed day depending on location. Home care is approximately 50% of that. Who wouldn’t be interested in that?  Intensive Care at Home is significantly — in fact, 50% — more cost-effective than an ICU bed or a prolonged stay in ICU. Depending on where you are in the world, funding may come from:

 

NDIS in Australia — we are an approved NDIS provider

TAC, Transport and Accident Commission in Victoria

DVA, Department of Veterans Affairs

Private health insurance

Departments of Health from hospitals directly

Self-funding

 

The key is to start the funding conversation early, ideally as soon as it becomes clear that your loved one will need home ventilation or Intensive Care at Home. We can help guide you through this process. Don’t leave it to the last minute.

 

Step 6: Put Together a Transition Management Team

Getting a ventilated adult or child home safely is not a one-person job. It requires a proper multidisciplinary team working together. Based on our evidence-based guidelines, the transition management team should include:

 

A team manager — an experienced critical care nurse who organizes and coordinates the care. The treating medical doctor, both in the hospital and in the community setting, can help with that the Intensive Care at Home nursing care team, all critical care trained; we put the team together, and you can be involved in staff selection if that is what you want

Equipment providers who must be briefed and present a social worker, social therapist, NDIS support coordinator, or case manager Allied health therapists as needed, speech therapy, occupational therapy, physiotherapy, dietitian. The health funding agency or health insurer

The family planning needs to start as early as possible. The team should begin planning the discharge from ICU the moment it becomes clear that home ventilation is the goal. Don’t wait until the last week, start now.

 

I also want to pick up on something I said to Peter directly on our call, because it is so important. I asked him whether the team was getting his mom out of bed, and the answer was no. She has been bedbound for weeks.

 

I want to be very clear about this, the BiPAP is not stopping her from getting out of bed. The TPN is not stopping her from getting out of bed. Every hospital has hoists, lifting machines, and comfortable recliner chairs. Getting a patient sitting out of bed for even 20 minutes a day can make an enormous difference to their strength, their lung function, and their overall trajectory. If your loved one’s team is not doing this, you need to ask why and you need to ask your loved one too, because nothing happens without their consent.

 

Step 7: Ensure the Home Environment Is Safe and Ready Before Your Loved One Comes Home.  The home itself needs to be assessed and prepared. This is not something families always think about, but we do, because it is critical.  Things that need to be checked and arranged include:

 

• Adequate electrical supply to support the ventilator and all associated equipment — a home circuit inspection is strongly recommended
• Appropriate space for the ventilator, suction equipment, and other medical devices
• Wheelchair access if your loved one requires a wheelchair — hallways, doorways, and room entries all need to be wide enough
• A clean, safe environment with adequate space for the nursing team to work.

 

If your loved one uses a ventilator during the daytime, the wheelchair may need to be fitted with ventilator equipment, this needs planning in advance. We work with families to assess the home environment as part of our discharge planning process. This is something we do routinely, and we can help you identify what modifications may be needed before discharge.

 

When Is Tracheostomy Ventilation Indicated Instead of Non-Invasive Ventilation? This is a question we get asked a lot. The indications for tracheostomy ventilation rather than non-invasive ventilation include:

 

• When fitting an appropriate non-invasive mask is impossible
• Intolerance of non-invasive ventilation such as BiPAP or CPAP
• Ineffectiveness of non-invasive ventilation
• Severe bulbar symptoms with recurrent aspiration
• Ineffective non-invasive management of secretions
• Failure to transfer to non-invasive ventilation after a period of invasive ventilation

 

This decision must always be made in accordance with the wishes of your loved one and their family, and in close consultation with the medical team. Don’t overlook secretion management — it can make or break a home discharge. One of the things that often gets underestimated in planning a home discharge for a ventilated patient is secretion management. It is absolutely critical, particularly for tracheostomy-ventilated patients. The nursing team must be competent in:

 

Regularly suctioning the tracheostomy from once to multiple times per day which is an intensive care nursing skill. Daily cleaning of the tracheostomy site and stoma dressing changes, changing the inner cannula at least twice daily changing the tracheostomy tube every 30 to 90 days, or in an emergency for non-invasively ventilated patients, secretions still need to be managed just differently. Techniques include manually assisted cough, breath stacking, and mechanical insufflation-exsufflation, such as a Cough Assist device.

 

According to our evidence-based Mechanical Home Ventilation Guidelines, a reduced cough impulse defined as a peak cough flow of less than 270 liters per minute, can lead to acute decompensation and an increased incidence of aspiration pneumonia. This needs to be on our radar from day one. That is why we are bringing intensive care nurses into the home and not support workers.

 

Step 8: Establish Monitoring and Documentation Protocols

Once your loved one is home, continuous monitoring and regular documentation are essential. For patients on permanent ventilation, ventilation parameters and measured values should be continuously monitored and documented at least once per shift. Clinical changes, for example, increasing spontaneous breathing times or deteriorations must trigger immediate medical consultation.  The nursing team must know exactly what to do in an emergency, and the emergency protocol must be agreed upon before discharge. More importantly, we are trying to avoid medical emergencies in the first place.

 

Pulse oximetry monitoring is particularly important for patients with neuromuscular disease and cough insufficiency, children, and adults on home ventilation, any patient where oxygen desaturation may be an early warning sign of secretion retention or clinical deterioration, which is essentially all of our clients at home.

 

Because this is about the quality of life for your loved one and your family. Sometimes when we talk about all these steps and all of these requirements, it can feel clinical and overwhelming. I understand that. But let me come back to Peter’s mom for a moment.

 

She is an 86-year-old lady. She has metastatic lung cancer. She has had strokes. She has been in the ICU since late December. The medical team has told the family repeatedly that there is no hope, that she is dying, that comfort care is the only path. And yet she told the doctor to give her back the mask. She said, unprompted, that she wants to go home. She is still making her own decisions. She is still here.

 

I said to Peter on our call, the best indicator that someone is not dying is that they are still alive and as long as your loved one is still communicating, still making decisions, still fighting, you have every right to fight with them and for them. The goal of everything we do at intensivecareathome.com is to give your loved one the chance to live a life with dignity, with privacy, and with the people they love in their own home, away from the stress and the noise and the clinical environment of an intensive care unit.

 

The evidence shows, and our own 15 years of Intensive Care at Home experience confirms, that mechanical home ventilation can dramatically improve quality of life for ventilated adults and children and their families.

 

In many cases it can also reduce the risk of hospital-acquired infections and complications that come with a prolonged ICU stay.  This is not just about survival. This is about dignity. It is about privacy. It is about living.  And that is what we are here for at intensivecareathome.com.

 

So, 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 a long-term stay in intensive care for ventilation, tracheostomy, home BIPAP (Bilevel Positive Airway Pressure), home CPAP (Continuous Positive Airway Pressure), ventilation without tracheostomy and tracheostomy care without ventilation, home TPN, home IV potassium, home IV magnesium, home IV antibiotic, and home IV fluids. We’re providing cough assist management at home, ventilation weaning management at home, central line, PICC line, Hickman’s line, as well as port management at home. We’re also providing nasogastric tube, nasojejunostomy tube, PEG, PEJ tube management at home, as well as IDC (indwelling urinary catheter) and SPC (suprapubic catheter) management at home as well as palliative care services at home.

We’re also sending our critical care nurses into the home for emergency department bypass services (https://intensivecareathome.com/does-your-hospital-want-a-home-ed-emergency-department-bypass-service-and-improve-ed-access/). We have done so successfully as part of the Western Sydney Local Area Health District, their in-touch program, saving approximately $2000 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.

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 Veteran 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’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 go from our first case study to advocate successfully for funding 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, who are 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.

 

Plenty of examples where clients with support worker models or even RN models without ICU experience have died at home and 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, and 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, and 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. They are, 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 bed 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.

This is also why we are providing NDIS Support Coordination (https://intensivecareathome.com/ndis-specialist-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.

 

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, in Albury, Wodonga, in Bendigo, in Geelong, in Warragul, and also in Wyelangta in Victoria.

 

If you have worked in critical care nursing for a minimum of 2 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 a tailor-made solutions for our clients which includes regular staff. Our clients also do want the same staff coming over and over again because they are so vulnerable and so special, that’s why we need regular, 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.

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 have to take the pressure off your ICU and ED beds, and 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. 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 (Emergency Department) beds.

 

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, 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.