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My name is Patrik Hutzel from intensivecareathome.com, where we provide tailor-made solutions for long-term ventilated adults and children with 24-hour intensive care nursing at home, where we provide tailor-made solutions for long-term ventilated adults and children on BiPAP (Bilevel Positive Airway Pressure), CPAP (Continuous Positive Airway Pressure) without tracheostomy with 24/7 ICU nurses at home, where we provide tailor-made solutions for long-term tracheostomy clients without ventilation, adults and children, with 24/7 ICU nurses at home.

 

We provide ventilation and tracheostomy weaning at home when medically appropriate. We provide cough assist management at home. Home TPN (Total Parenteral Nutrition), home IV (intravenous) fluids, home IV antibiotics, home IV potassium, home IV magnesium, home central line, PICC (Peripherally Inserted Central Catheter) line, Hickman line and port management at home, IDC (Indwelling Catheter) and SPC (Suprapubic Catheter), PEG (Percutaneous Endoscopic Gastrostomy) and PEJ (Percutaneous Endoscopic Jejunostomy) tube management, nasogastric tube and nasojejunostomy tube management at home, as well as palliative care management at home. We’re also providing Level 2 and Level 3 NDIS (National Disability Insurance Scheme) support coordination, as well as TAC (Transport Accident Commission) case management.

 

Today I want to share an email that I received from a reader overseas in America. A few months ago, he contacted me about his mom, who was on a ventilator, on dialysis, had a PEG tube and a jejunostomy tube. Sadly, she passed away last month, but his email and his situation is highly relevant for what we do here with Intensive Care at Home, whether on a national or on an international level.

First of all, I want to say how deeply sorry I am for this family’s loss.

 

With his permission to share his message, I’m reproducing his email here word for word, because it raises questions that so many families of ventilated patients in ICU ask us every single week. Is my loved one really ventilator dependent? Can they come home? And what happens when the care they are receiving isn’t safe? So let’s read out his email word for word.

 

“Hi Patrik,

 

A few months ago, I contacted you about my mom: ventilated, tracheostomy, dialysis, PEG tube and PEJ tube.

 

Unfortunately, she passed away last month due to a number of errors at the hospital and care center, and it will result in a number of lawsuits to be filed.

I want to just say thank you for the work you and your team do. It was ironic. At one hospital, they said she was ventilator dependent and was treated that way for 5 months. She went to a teaching hospital. They put her on CPAP settings for 2 days, then put her on the Airvo, and they had her down to 15 L at 30 L flow. They told us a ventilator and a tracheostomy takes 24-hour nursing care at home. I talked to our pulmonary doctor and said, ‘I used to be an EMT (Emergency Medical Technician).’ And he said, ‘Of course, you can do a vent and trach at home with 24/7 ICU nurses.’

 

The biggest problem was dialysis, but we might have found a way around it. But just as we were running out of time, rather horrible care caused her death: from sepsis, the lung infection, bed sores, to not hooking her up to oxygen and the oxygen monitor for almost an hour, to sticking a displaced PEG tube back in that was dirty and not using a new one, the jejunostomy tube that wasn’t flushed and was chocolate brown, so either not flushed or blood, suction canisters that had black stuff in them, and nurses accessing her dialysis port for IVs, a big no-no according to nephrology, and I can confirm that here.

 

So my friend, bless you for the work you do, and continue on. In many cases, people can come home. Yes, it will be a lot of work, even with 24-hour ICU nurses, and many family members might shy away and just don’t want to do it. But for the ones willing to do it, and willing to engage Intensive Care at Home and work with you and learn, it can be done to help take care of their loved ones.

Today I see so many people thrown into the nursing homes. Too many lives cut short by hospitals and ICUs wanting to withdraw treatment prematurely, and nobody never sees them or visits. One of the first questions on the intake form is, which funeral home? What has come of us as a society?

 

Godspeed and blessings to you and Intensive Care at Home.”

 

So just as a note, this email is reproduced word for word. Like I said, the reader has given me authority to publish his email here. Please note that the events described in this email are the family’s own account, and I have no access to this patient’s records. I can’t verify the details, and I won’t comment on any individual hospital or care facility. Of course, what I can do is use this email to explain the clinical issues it raises and what families actually want in a situation like that, so that other families know which questions to ask.

 

So let’s now look at the clinical picture and what this email is telling us.

 

Number one, ventilator dependent for 5 months, then CPAP and high flow within days. The most striking part of this email to me is that one hospital labeled this patient as ventilator dependent and treated her that way for 5 months. She then went to a teaching hospital, where she was tried on CPAP for 2 days and then moved to high-flow nasal cannula, or high-flow nasal oxygen. The family mentions an Airvo, which is a high-flow nasal oxygen device.

 

I see this pattern over and over again. The term “ventilator dependent” gets written into the notes, and from that point, it can shape every decision that follows, including discharge options or lack thereof. It can determine funding and whether anyone attempts to wean at all. But ventilator dependency is an assessment at a point in time. It should be reviewed regularly, especially when the underlying causes may be reversible or variable.

 

Number two, a multi-system patient: ventilation, dialysis and two feeding tubes. This patient needed support for her lungs, her kidneys and her nutrition at the same time. Each one of these on its own requires ICU nurses. Together, they need someone at the bedside who understands how they interact. For example, fluid removal on dialysis affects breathing. An infection anywhere in the body can make weaning much harder.

 

Number three, the complications described. The family described sepsis, a lung infection, pressure injuries, also known as bed sores, a period of almost an hour without oxygen or oxygen monitoring connected, a displaced PEG tube that they saw was cleaned and reinserted rather than replaced, a jejunostomy tube that appeared dark brown and possibly unflushed, dark material in suction canisters, and nurses accessing dialysis catheters to give IV medications.

 

Without commenting on this case, here’s why each of these matters in any ventilated patient.

 

Number one, oxygen and monitoring. A ventilated or high-flow patient should never be left without prescribed oxygen and continuous monitoring. With 24/7 ICU nurses, minutes matter.

 

Number two, PEG and PEJ tube care. A displaced gastrostomy or jejunostomy tube needs its position confirmed and should be managed according to protocol, using clean or new equipment. Jejunal tubes block easily and must be flushed regularly.

 

Suction equipment, suction canisters and tubing should be changed and checked regularly. Unusual secretions should be reported and investigated.

Dialysis catheters. In most hospitals, these lines are reserved for dialysis only, because using them for other purposes increases the risk of infection and of losing the line, which is the patient’s lifeline for dialysis.

 

Pressure injuries. These are largely preventable with regular repositioning, pressure-relieving equipment and skin checks.

 

So why does this happen? I’ve worked in critical care nursing for over 25 years in three different countries, where I worked as a nurse manager for over 5 years in intensive care. I was part of a pioneering Intensive Care at Home nursing service in Germany 25 years ago, before I brought the concept to Australia in 2012. That’s how long we’ve been operating for.

 

And I’m also running a consulting and advocacy service for families in intensive care, and you can find that on our sister site at intensivecarehotline.com.

And I’ve seen that most complications in long-term ventilated patients come down to a handful of causes.

 

Number one, skill mix. Especially outside of ICU, many facilities are not staffed with critical care nurses that have ventilation, tracheostomy and central line experience, because all of this needs ICU-level training and experience.

Number two, staffing ratios. In an ICU, a ventilated patient usually has one nurse for one or maximum two patients. In many facilities or care settings, one nurse may look after several patients, or sometimes there are not even nurses, let alone ICU nurses, available.

 

Number three, fragmented care. When multiple teams, such as respiratory, nephrology and nutrition, are involved, things can fall between the cracks if nobody is coordinating.

 

Number four, low expectations. When a patient is labeled as “not going to improve,” weaning and rehabilitation may never be attempted.

 

I often compare this to flying a plane. You wouldn’t put someone who isn’t a qualified pilot in the cockpit of a passenger jet. You wouldn’t ask the cabin crew to fly the airplane instead of the pilot. Same here. A ventilator, tracheostomy and a dialysis line are the cockpit. They need qualified critical care registered nurses at the controls 24 hours a day, whether that’s in ICU or at home with Intensive Care at Home.

 

So what are the options?

 

Number one, ask for a weaning assessment and a second opinion. If your loved one has been labeled ventilator dependent, it is reasonable to ask the treating team: When was weaning last assessed? What is stopping it? Is a referral to a specialist weaning respiratory physician, a teaching hospital, or at home with Intensive Care at Home possible? You are entitled to ask the right questions and ask for a second opinion at all times.

 

Now, home ventilation with 24/7 ICU nurses, or critical care registered nurses. The family’s pulmonary doctor told them a ventilator at home is possible with 24/7 ICU nurses, or CCRNs (Critical Care Registered Nurses). This is exactly what we do. Long-term home ventilation with tracheostomy is well established in Australia, and mainly in Germany, and it is supported by evidence-based guidelines that we follow. You can read our summary of the evidence, the Mechanical Home Ventilation Guidelines, on our website at intensivecareathome.com.

 

The family also says that dialysis was the biggest barrier, and this is a genuinely complex situation, and every case needs to be assessed individually with a nephrology team as well. Depending on the patient, options may include peritoneal dialysis, or home hemodialysis, or transport to a dialysis unit with a nurse and portable ventilator and all the backup equipment. None of these are simple, and they aren’t suitable for everyone, but they should be discussed rather than ruled out by default. It can absolutely be done at home and in the community.

 

Also, this family ran out of time. It requires early discussion, not last-minute discharge. Planning a safe discharge home takes weeks, sometimes months. Funding needs to be in place, equipment, nurse recruitment, and sometimes training, and family education and family involvement in all of this. If home is the goal, start the conversation early.

 

And whether you’re trying to get your loved one home, questioning a “ventilator dependent” label, or have concerns about care, the medical records are essential. Ask for the complete medical records file, including but not limited to nursing notes, doctor’s notes, observation charts, fluid balance charts, ventilator and oxygen settings over time and any weaning trials, medication charts, including what was given through which line, laboratory results, pathology, wound and pressure injury assessments, and incident reports. Leave no stone unturned.

In any English-speaking country, you can usually request medical records from the hospital or through freedom of information. And it doesn’t matter whether it’s in Australia, UK, US, wherever you are. Patients and their authorized representatives have a right of access.

 

If you have serious concerns about care, you can raise them with the hospital’s patient liaison services, but you can also raise it with us here, as we obviously know how to talk to hospitals. You can complain to your state’s health complaints body, or, for concerns about an individual practitioner, you can report to the nursing board or medical boards. For legal questions, please get independent legal advice.

 

And here’s how we can help. If your loved one is in ICU or long-term care anywhere in the world, and you need help understanding what is happening, advocating for weaning, or planning a discharge home, go to intensivecareathome.com. We are currently operating all around Australia, in all states and territories, in all major capital cities, as well as in all regional and rural areas. But even if you are in the US, in the UK, in India, in Canada, wherever you are, and you are interested in Intensive Care at Home, please reach out to us as well. We can help you there too.

 

And you can contact me on one of the numbers on the top of our website, or if you’re in Australia, you can contact me on my mobile phone, 041 094 2230. Again, 041 094 2230. You can schedule a call with me by clicking on the schedule appointment button, or you can send me an email to [email protected].

 

Also, with Intensive Care at Home, we are currently, in 2026, the only third-party accredited Intensive Care at Home nursing service. We are accredited through ISO (International Organization for Standardization) 9001:2015, as well as NDIS registered. You can read more about our accreditation and quality standards on our website at intensivecareathome.com. I put a link to that in the show notes. And we have been operating since 2012, and we have supported clients all around Australia. And like I said, I was working in this space in a pioneering service in Germany 25 years ago. Big shout out to Brambring Jaschke in Munich.

And like I said, we are a registered NDIS provider. We work with TAC, WorkSafe, DVA (Department of Veterans’ Affairs), aged care, private funding, departments of health and hospitals directly.

 

And home is definitely the right choice for many patients, but it’s also not the right choice for all patients or for every family, because it is a lot of work. But for families who want it and are willing to be part of the team, it deserves to be a real option, planned properly and staffed with the right nurses.

 

Also, from a funding perspective, an ICU bed costs $5,000 to $10,000 per bed day, whereas Intensive Care at Home costs around 50% of that. So any funding body will automatically have an interest in starting that conversation.

Now, also, if you’re going to hospital all the time for your family member, that also takes a lot of time and energy. You might as well spend that time and energy on trying to get your family member home.

 

So, frequently asked questions that come out of today’s video.

 

Can a ventilator-dependent patient go home? Many can, with a tracheostomy, home ventilator, the right equipment and 24/7 ICU registered nurses. Each patient needs an individual assessment by their treating team.

 

Number two, does a ventilator at home need 24-hour nursing? Absolutely, yes. Patients on invasive ventilation with tracheostomy, but even non-invasive ventilation without tracheostomy, and even tracheostomy without ventilation, patients can deteriorate within minutes, sometimes seconds. For example, the tracheostomy tube blocks or displaces. So a critical care trained nurse should be present 24/7.

 

Next question: Can someone be weaned after being labeled ventilator dependent? Sometimes, yes. Ventilator dependency should be reassessed regularly, as factors such as infection, fluid overload, deconditioning and nutrition can change over time. Again, ask the treating team when weaning was last assessed.

 

Can a patient on a home ventilator have dialysis? It can be possible, but it can be complex. Options depend on the patient and must be planned with a nephrology team. It could be peritoneal dialysis at home. It could be going to a dialysis center. It could be doing home dialysis.

 

How do I get my loved one’s medical records? Ask the hospital’s medical records or freedom of information department. An authorized representative, such as a medical power of attorney or next of kin, can usually apply on the patient’s behalf.

Also, is Intensive Care at Home accredited? Yes, absolutely. Intensive Care at Home is ISO 9001:2015 accredited for Intensive Care at Home nursing, as well as NDIS registered, and we are the only third-party accredited Intensive Care at Home nursing service in Australia. We have built the policies, the procedures and the intellectual property from scratch.

 

Here’s the bottom line. The email is heartbreaking, and my thoughts are with this family. It carries three lessons for every family with a loved one on a ventilator. Question labels like “ventilator dependent,” and ask for regular weaning assessments. Get the medical records, and ask questions when something doesn’t look right. And if home is the goal, start planning early and insist on the right level of care right from the start: critical care registered nurses 24 hours a day with Intensive Care at Home. If you need help, go and contact me at intensivecareathome.com.

 

Disclaimer: this video is general information only and is not medical or legal advice. Please talk to your treating team about your loved one’s individual situation as well.

 

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 andIntensive Care Hotline. 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.