INTENSIVE CARE AT HOME Brisbane Networking Event

Amanda: Good evening, everybody. I’d like to welcome you all along to our networking event this evening. Can everybody hear me okay?

Audience:   Yes.

Amanda:  Or otherwise I’ll have to get the room microphone. So I’d like to welcome you all along, and thank you so much for coming. We are holding these events all over the states at the moment.

And this is to get like-minded providers through that provide medically complex supports to people across all over Australia, to get our networks nice and tight, that we’re able to refer and trust the people that we’re referring to.

But also letting the hospitals, and also allied health professionals and thing like that know that we’re here, and we’re able to support as well on the other side of things including from our nursing care, through to our support coordination, and just advice at the Intensive Care Hotline as well. So, just to help out with that.

So first of all, I will welcome Trevor from ResMed to come up and have a chat, and he’s going to tell us a little bit about ResMed.

Trevor Forward:   I’m Trevor Forward, like probably a lot of you would know. Trevor Forward, the New South Wales sales rep, and we look after a particular amount of ResMed products. Of course, here’s our portfolio.

So, basically with ResMed, we cover obviously valuable products, as well as health information range of products, and where we get involved in this space, supplying the products obviously to the patients within the hospital with all different types of respiratory issues.

Myself, doing the initial setup in the hospital, patients coming to ICU, MND patients that need support, and all some sort of innovation in our new products. Can you get to the next slide?

Amanda:   Yeah.

Trevor Ford:   So basically, our theme of our portfolio, it is basically AirSense 11 and AirSense 10 range, and then of course we have our other products, valuable products that we supply within hospitals, and in the private sector.

On the respiratory side of the products, we obviously supply a range, the Stellar, and obviously that Stellar 150.

Although all the devices are connected by AirView, remote connectivity, and these are supplied and supporting patients within the community.

About a couple of years ago, say about five years ago, Becky, I think, we met, and I thought that talking to Patrik and thinking about what Patrik would and Patrik does, I think it’s a good place for us to collaborate and network, and bring other players that is in the same industry together to support a lot of these patients in the community because from what we see, and I suppose a lot of you are aware as well, support for the patients is a lot absolutely needed to be safe while supporting these ventilation patients, and it’s quite risky.

We’ve had a couple of incidents where some of these situations were pretty difficult, and I just thought that it’s great that we can actually work together and can support each other. That’s about it.

Audience:  That’s great.

Trevor Forward:  Okay. Thank you very much.

Amanda:  Okay, so we would to welcome Dionne to come and talk about our nursing services.

Dionne:   Thanks, everyone. I don’t have a PowerPoint, so sorry about that. And I’ll come straight, I’m not a great public speaker, so please bear with me.

First, I’d like to thank you all for coming and spending a few hours with us, really appreciate you all for taking time from your busy schedules, so thanks so much for coming in and spending your time with us, and for having a listen to some of the talks here. We’ve had some really good connections here tonight.

So I’m Dionne, I am a clinical service manager for Intensive Care at Home, and that’s really just, I suppose another term for jack of all trades.

I came to the company with previous experience within things like healthcare internationally, 25 years of that in the ICU setting, and actually specifically pediatrics, and other roles that are encompassing Intensive care units.

My Intensive Care at Home journey started in about 2018, so quite some time ago now. 2018 for my family was a fairly difficult year, 2019 as well, and we had some pretty heavy moments in and out with medical issues.

What I found during the journey, my son and his heart failure, and all the other things that went with that, it kind of felt like I was just being brought along on a journey with the right people coming to our world at the right time, and helping us through this.

It is with each horrible situation that happened, can we just say that the right person had entered our lives, and helped us get through what was happening next in our lives.

So I was up one night, and I was doing what I normally did, because I didn’t sleep for that night, over a year and a half, and that was researching and reading journal articles over the internet coming from all over the world. And the people that came up, it was Intensive Care at Home. It caught my eye, and I thought, well that’s incredible, that’s pretty interesting. So, I had a look, and I think I got it, and I thought, “Oh my goodness, man, this is amazing. This is something that’s really needed.”

As part of my role as a nurse in the ICU, we would often transition patients home, and in pediatrics, I’ve cared for children with ventilation, tracheostomy, and how to care for not only their child as a child, but also to be their medical professional as well, and I thought, “Oh, that’s amazing. What an amazing service.”

Then, I had this sick feeling in the back of my throat because I thought, “Hang on, during this whole journey of what’s happening to us, the right people came on at the right time.” So in my head, I thought, “Oh my goodness, the next thing it’s going to be that my son is going with me with Intensive Care at Home. That was just my logical train of thought. This is going to be our next part of the journey, and I felt quite dejected. I went to bed that night and look at the ceiling, and just yeah, it was a pretty horrible feeling.

I got up in the next morning, and I had reflected quite a bit overnight, and I thought, “Actually, this is a good thing.” Because now I know that if this is a daily thing going on, Intensive Care at Home exists, and they’re doing this stuff already. So if that’s the pathway that my son goes then, I’m not going to be expected to be the expert looking after him at home. There’s people that are doing that, a company, and they’re going to be supporting for me.

In my head, that helped a lot, and I actually thought to myself, “Okay, well that’s Intensive Care at Home. Now I know that if that’s a bad thing that happens, this is the company I go to. Let’s put it on my favorites list.” It goes up there with all the journal articles, and I thought, “Okay, that’s great. Well done.” I’m happy to say that the next year or so, it was a better part of the journey, and my son successfully got his heart transplant, and he’s living his best life at the moment.

Then a couple of years back, I was again finding myself at the journal articles, and trying to research and research, because unfortunately that the effect of the stress of that actually kicked off my part of the heart failure. I found myself unable to work anymore. I couldn’t come back to my job as a nursing director and I found myself back at home, researching, how do I keep myself and all of these kids? What can I do? What drugs are out there? Sure enough, again it popped, there’s Intensive Care at Home again with the solution, and I’m like, “Okay, so it’s happened a second time, and this time it wasn’t because my son needed them.” So I thought, well hopefully, it’s not me.

This time, I’m going to pick up the phone, and I’m going to talk, and see what’s the deal. Luckily there, Patrik answered the phone, and he talked to me about his company, and his ethos, and I got an offer. An hour later, I got off the phone, and I thought, “Do you know what? I got a new career, this is amazing.” Because, having spoken to Patrik, I realized that, while I was stuck in this physical body that wasn’t doing what it should do, Patrik had saw a different side of me. He actually saw that I had this ability, and these connections, and this knowledge that I built up over 30 years, and I was sitting at home feeling so useless, because my heart was broken, and I wasn’t able to talk in one to three-word sentences, but he didn’t care what my physicality was. He just wanted to lift up my brain because at that time, I just don’t want to use that.

It’s not one of my high points, but he saw more in me, and said, “Hey, we want to open up in Queensland, and I think you’ve got what it takes.” In all honesty, I think it reflects that every time that Intensive Care at Home came up was for me to go on this part of the journey. For me, I got this renewed vigor in life, because as cliché as it sounds, I’m a nurse because I care. I’m a nurse because I want to care for people, and make people feel better.

All of a sudden, I had this opportunity to keep doing that, despite this my physicality, and so the journey began. So for about a year and a half, I probably spammed most of you with emails about how wonderful our service is, and probably for about the last three years, we’ve had some clients that we have been caring for. We’ve really successfully shown what we can do with Intensive Care at Home by bringing home one of our first things I mentioned, complex clients who left hospital three months ago, began with Intensive Care at Home nurses and it hasn’t had to go back. I didn’t really think that was such a big deal, because there’s lots of new nurses working for about 12 hours a day.

I went back to the hospital just recently, because they recruited another patient, and I sat in the room with the same stakeholders that had referred this client to us, and they just went, “Oh my god, I’m so glad you’re here. Thank you so much for what you’ve done.” And I’m like, “That’s not my job, I don’t know what you’re talking about.” They’re like, “We have never had a client transition home, that’s been complex here and that hasn’t bounced back in two weeks.” And he’s been home now for three months. I’m like, “Okay, actually that’s a pretty good deal.”

We’ve only got two KPIs that are major KPIs in the company. One is to ensure that our clients don’t go home without nurses, and the second is, no unnecessary or unplanned returns to the hospital. I take it for granted that that’s what we do, but that’s what we do. That’s the difference in Intensive Care at Home. They have the skill, they don’t need to see the problems before they begin, they’re preventing these issues from occurring, and we work hand in hand with support workers. We work hand in hand with allied health, and we all bring to the table something really important to help these clients achieve what they want, which is not to go to ICU anymore.

I’ve spoken to those of you that work in hospital that are here tonight, that they really don’t like you. They don’t like it there. I was one of them too. I didn’t like it either. They liked being at home. I was off saying to some of the nurses in the corner, we’ve had clients who have gone home with palliation. They’ve been called out of hospital, that’s it, you’re done. They go home to live out their lives. Then years later, we still have those clients with us today.

The difference that it makes, having these clients home in their own environment, where their value adding to their families and the structure they’re holding to. They’ve got their dogs and cats sleeping on the bed with them, and they have purpose in life again. Of course they have their medications, and all those monitors and machines to keep them alive, but it’s just the difference that, these clients being home, and also being home with the right care, and the right provision, and the right preventative care.

Nurses aren’t magic, but we can certainly do a really good clinical assessment, and you can see some problem before they go and begin. There’s not a nurse in this room who doesn’t have a clinical judgment which is essential for us. It would be a phone call right away saying, “Hey, there’s something’s going on here.” It’s not waiting until that client gets unwell, and then needs a transfer to the hospital, and sits in ED for 8 hours, and goes through that whole process. We’re preventing that.

In fact, we did do a formal service in New South Wales where we had a contract for New South Wales as an emergency department bypass service, where our nurses would go out to nursing homes and so-forth, but just to help clients with nasogastric tube problems and external catheters problems. These clients would normally have to get in an ambulance, go to the hospital, sit in ED to get their changes done. Everyone knows that old people in ED have a short span for their life longevity. But we were able to provide that service, and use the main services, ventilation and tracheostomy services, and prevent doing that part for these patients.

For me, that’s the things that make me get that feeling in my tummy. That’s the reason I became a nurse, and that’s the thing that makes me tick, and I can feel like I did the job today. I did the right thing for them.

So I’d have to say, this is probably the job that’s probably given me the most rewarding job satisfaction I’ve had in my whole 30-years career. I love to challenge Patrik, and Patrik also love to challenge me, but that’s what makes it a really good service, because without that, we don’t get feedbacks and we don’t get improvements.

So again, thank you. Thank you for coming, thank you for hearing us and having a conversation about us. If you have about clients that could do at least have a conversation to say that there are other options and share maybe what we’ve got at the moment, we would be more than happy to make their lives a bit easier.

So yeah, that’s me. Thank you.

Amanda:   Thanks very much, Dionne, for giving us that insight.

So, I will talk a little bit to the support coordination, and what that looks like for us in Intensive Care at Home.

Amanda:  I will talk a little bit about the support coordination side of things. Some of you, I’ve already spoken to in the room, some of you may already know me. So, Intensive Care at Home decided to take on support coordination just within the last 12 months, because we’re noticing quite a bit that support coordinators didn’t really know what they were doing when it come to a lot of complex clients. I’m not saying all support coordinators, believe me, there are some really dynamic ones out there, and I do not know everything. There’s not enough room in this brain for that.

So, we were finding that a lot of people were being exited without some of their supports that they really needed. We’ve just been coming in and consulting from hospitals, or from homes, around what people need. Linking them in with the community, OTs (occupational therapy), physios, that sort of a thing, then linking in with the hospitals. Then discussing it altogether to make sure that we’ve got a really dynamic plan for that person to leave the hospital with, whether that’s for equipment that’s being ordered, that type of thing.

I am not from a clinical background, but I have an entire nursing team that I do draw from, and also all of the allied health professionals that we work with. So quite often I’ll come back to the office and ask, well, that’s the office we’re 100% remote. So I’ll call up Dionne, I’ll call up Patrik, and I’ll say, “I’ve just had an intake or an inquiry with a possible NDIS participant, or a future NDIS participant. They told me about this really rare disease that I’ve never even heard of, and I have no idea where to start.”

So generally, 9 times out of 10, they have heard of it, or they’re going to find this information on it, and then together we develop a bit of a plan, and take that back to the NDIS participant, or future NDIS participant, and say, “This is what we can do for you. This is what we’ve come up with. This is what the supports could potentially look like for you.”

Obviously one of the biggest things within support coordination is choice and control, and making sure that all NDIS participants have a range of services that they’re able to choose from. Some of our medically complex participants don’t have very many to choose from, so offering them a choice, there might be two.

I’d like to sort of use the respiratory physios as one of the examples. There’s probably two, three in Victoria that we have used. It’s very rare to be able to get a respiratory physio that has availability, which is another big thing there isn’t a wait list for. A lot of our participants require it now, not in three months, six months’ time, because the respiratory physios are very unique.

We obviously need to build our network to make sure that we have a really great referral network for that, so I can say to our NDIS participants, “There’s six choices, how about that? These are the pluses, these are the minuses, these ones have wait lists, these ones don’t. How about that for choice?” Then I don’t have to go searching for them, is the other thing.

So one of the biggest things is, because of the complexity of some of our participants, or people that we’re supporting, patients from hospitals, is the community might not have those specialists that they wanted, or access to those specialists that they have in an ICU ward so I need to try and match that person in the community.

We have worked very, very closely with a lot of other providers as well for support coordination so participant can have 10 support coordinators if they want to but I don’t recommend it. It gets really confusing if you get any more than two, but they can. So one person might specialize in housing. I don’t specialize in housing, so I would be reaching out to someone and saying, “I need help on this because that’s not my forte.” So we link in, we’ll work together. Even one of the coordinators may withdraw supports, they may stay on and they may continue to work together.

So I guess for myself, this evening is really about collaboration, getting to know some of the amazing people that we have in Queensland. We do have participants here that we do support coordination for, and also within the community that have nursing care, and we just want all of the best people that we can refer onto, and making sure that that network is really strong for the people that we support.

Does everybody sort of know what support coordinators do? It’s relatively self-explanatory in the title. But in a lot of cases, we’re also liaising with the hospitals, we’re liaising with housing, we’re liaising with justice, in some forms, and we’re liaising with child protection. So we’ve got all of these other potential funding bodies that we’re also talking to, to try and get everyone to sort of meet in the middle, which can be a little bit tricky to try and coordinate sometimes. But that’s also part of our role as well.

We’ve found that the NDIS will try and give them two support coordination to a lot of our complex participants. Technically, it should be under Level 3, which is for more complex people. So one of the definitions is that a Level 3 support coordination is liaising with multiple agencies such as justice, child protection, and housing. We might not be liaising with them, and that’s usually where you’ll get complex funding or NDIS funding for.

But for medical participants, we’re liaising with the hospitals, we’re liaising with the community, we’re liaising with other funding bodies to try and get the supports, because not all the time, the NDIS is going to cover everything that they possibly need. So it takes a lot more than just NDIS funding to assist someone to integrate back into the community properly. So that’s essentially what we’re doing at the Level 3 support coordination level.

Level 2 is set up and designed so that you can teach and assist the person to be able to implement their own NDIS plan. A lot of the people that we are supporting, that probably won’t be possible, or it’s going to take a lot longer than a couple of years for that to happen, or at all.

So, I guess that’s pretty much what we’re doing with Intensive Care at Home I’ve worked with a couple of support coordinators here in Queensland, and just had a chat with them about different tactics that they could take to assist participants, and try this to get that person out of hospital.  We’ve had many conversations with different people to try and assist, and all of that has been at no cost to the company.

Patrik:   Thank you so much for joining our networking event in Brisbane. I really appreciate for tonight. Thank you, Dionne, thank you, Amanda, for doing most of the legwork setting this up, and thanks again for joining us.

I want to talk a little bit about where we got started, and what has brought us here today. Some of you might know that I worked as a critical nurse by background. I did my nurse training in Germany way back when, and I ended up working with Intensive Care At Home in Germany, in Munich, in 2001 I think, and we were basically the first company then to set up Intensive Care at Home and it was a huge success.

So then I went home, continued my nursing career in the U.K., and I eventually came to Australia, all the while, while working in the ICU and all I can see in ICU was patients that we would’ve looked after over in Germany, that’s all that I could see. A niche market, right?

Basically not many patients in the ICU need that type of service, but it’s certainly a significant number. It’s also a growing number of, I think Dionne and Amanda, you mentioned patients with MND (Motor Neuron Disease), spinal injury clients, patients with cerebral palsy. Our resident nurses are here and you know what type of patients are out there.

But there’s also an element of what we’ve always focused on, there’s also an element of end-of-life care at home for ICU patients. I believe, palliative care in ICU is extremely important, and if you ask patients and families where they would they want to approach end of life, 75% want to die at home and in Australia, less than 15% actually do die at home.

So are we really certain how’s the population when it comes to end of life? I don’t think so. We are certainly making a difference there when it comes to improving quality of life, and probably also in the quality of end of life in the home care setting.

Fast-forward, so I started the business in 2012, and I also want to mention something here. I never started this business because of NDIS, thinking if they were there. I have no idea in 2012 that the NDIS would be a teamwork. I started this business because I believe there is a need for what we’re doing. It hadn’t anything to do with the NDIS in the early years. We got funding through the TAC. I’m not sure if many of us here are even familiar here with TAC, the Transport and Accident Commission.

The equivalent here in Queensland is NIISQ. Don’t know what that stands for, but…

Audience:  National Injury Insurance Scheme

Patrik:   Right, and that was sort of the gateway for us in 2014, yes to definitely help us to open the doors, but that was sort of the gateway in 2014 to prove our concept. Because prior to that, when I was going out there to buy some new tools and equipment, I was told, “Well, you can’t do this at home.” I said, “Well, we’ve done this back home in Germany, so why not?” It was never a question to me that it wouldn’t work. It just needed a client to prove my concept.

Our first client in Melbourne at the time was a C1 spinal Injury client who was looked after by support workers at home. That’s our very first client with tracheostomy who was looked after by support workers at home. Of course, he bounced back in and out of ICU because they couldn’t keep him home, and the TAC eventually came to us, and also the ICU came to us saying, “Hey, we’ve heard of this service. The client doesn’t want to be here. We don’t have the bed space that we need, and someone’s paying double for an ICU bed that we could charge at home.” So in my eyes, that’s a win-win situation.

So anyway, we started with this client, and we proved our concept in no time. When we worked this client, this client never went back to ICU. That’s what Dionne said earlier. What do we measure in our services? Two things we measure, no more than that. One thing we measure is how we get all shifts filled, and number two, are our clients at home?

Because if they’re not at home, we don’t have a business. So that’s pretty much all we got on this one, and the reason we can focus on that, seemingly, that I believe we hand select our staff. We want the minimum of two years solid ICU nursing or ED experience, ideally with a postgraduate critical care nursing qualification. That’s what we focus on.

I don’t have the exact stats, but I do believe, certainly by presenting our staff with critical care nursing qualification, that’s very similar to what ICUs have. So I think we can proudly name our service Intensive Care at Home because it’s not the fancy name, it’s not only for marketing, it is actually what we do.

I think we have really changed and transformed lives over the years, from families that were literally living in ICU, that were absolutely asking help for their experience, then going back home to a stable, predictable environment where they can actually start living their lives.

We have some clients where both parents could no longer work because they were either full-time parents at home, or they were balancing between the ICU and home and some of them I believe saved from going into poverty, because all of a sudden they were able to go back to work again. Like I said, I think we really transformed some lives over the years.

Another thing I forgot to mention, and I really want to thank also all of our nurses on the road that are out there right now, as we speak, looking after a growing number of clients in the community whether it’s now in Victoria, New South Wales, or Brisbane. I really appreciate and thank these people.

Also, can you draw the people that are working tirelessly in the background, which is our admin team, our staffing team, whether it’s our rostering team, whether it’s our finance team, whether it’s anyone new on our team, nothing will ever work without them. So there’s so much we’re going on the background that I can’t stress enough. The work that we do almost around the clock to keep the patients at home, keep the clients at home, and have that predictability of clients at home, because that’s what they’re looking for. They want to be at home, really.

Another thing that we obviously learned over the years which is where I think really tied in with what Amanda said, some of you in this room may have funding constraints in the community, especially around NDIS. From my point of view, it’s a perceived funding issue. Because funding for our service, and I know a lot of you in this room know that there’s sometimes support workers looking after ventilated and tracheostomy clients.

In my mind, that is very often a death sentence, and I have evidence to back me up with what I’m saying, and we never had an issue of funding for our NDIS clients to provide NDIS support. It’s never been an issue, I think, which is why we eventually went down the track of hiring Amanda: to provide this service in-house because it has been very much hit and miss over the years with the NDIS support coordination side of things, but it’s never been hit and miss with the right NDIS support coordinator.

NDIS, in the end of the day, is an insurance scheme, and just like any other insurance scheme, if you tick certain boxes, and you can provide the evidence, then funding will pull off. So that’s certainly something that we’ve seen over the years, but we’ve also seen these on the other extreme, with the wrong NDIS support coordinator, the patient and died, and people have died.

It was because of lack of funding for critical care nurses, and people have died because support workers were looking after them. Obviously, we’re very straightforward with that because we know of at least 5 or 6 clients in the community that have died because of the support worker model.

If the NDIS wants to continue going down that track, that there will be more casualties along the way. We believe that we now have correct structure that our clients need to feel safe and be looked after, 24 hours a day, instead of support workers.

The other thing that I want to say on that note, our service is actually evidence-based, so what do I mean by that? When you look at our website, intensivecareathome.com, there’s a section where it says Mechanical Home Ventilation Guidelines. So, when you look at this section, there’s research that comes out of judgment when Intensive Care at Home first started saying that it is only safe to look after ventilated plus minus tracheostomy if you have a team of 24/7 critical care nurses with a minimum of two years critical care nursing experience. It’s all evidence-based.

The NDIS can’t tell me that the support worker model, that clients have died, and they have evidence, and that it’s evidence-based. I’m just putting that out there that in healthcare, or in disability care, we should be going back to evidence-based care, and not to what’s cheapest, because we actually have peoples’ lives in our hands, and we mustn’t forget that. We must value the lives of our clients.

In the meantime, so when we first started in Victoria in 2012, we did eventually then start getting some clients in New South Wales that came organically. It wasn’t like we’re trying to branching to New South Wales. It was really word-of-mouth, spreading to New South Wales eventually, and we were actually starting there during COVID when we couldn’t even interview people in-person. We had to interview staff online, which worked out fine in the end, and then almost all support staff had to grow organically here, and increase in 2021 when one of our Melbourne-based clients has moved out here.

They asked us, “Can you find us some staff in Brisbane?” Which we did, and then Dionne contacted me at some point wanting to work for us, which was really a godsend. With Dionne’s contacts and also with her insights into what’s happening in Brisbane and in Queensland, especially in the pediatric ICU world, has been extremely invaluable for us.

We are now having a small but growing nursing team here in Queensland. So, thanks Jane, for coming tonight as well. We have admin staff here tonight as well. Thank you, Chloe, for joining us as well, and also supporting is our HR manager who is also here.

So, thank you everyone for joining us tonight. I want to wrap this up here now, because I think we’ve got some food coming but if you have any questions, please, now is the time to ask your question.

Amanda:  Or we might do it later after dinner. All right.

So thank you very much, Patrik. So stay a bit so that we will continue the food as it comes out, it won’t be too long.

Patrik, we thought you would probably be talking longer than that. So the food should be out in the next sort of 10 minutes or so anyway, but please chat amongst yourselves or if you’ve got any questions, come and talk to anyone of us. More than happy. Thank you so much, all, for coming.