Podcast: Play in new window | Download

 

My name is Patrik Hutzel from Intensive Care at Home at 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), and non-invasive ventilation, where we provide tailor-made solutions for clients, adults and children with tracheostomies without ventilation, where we provide home ventilation weaning, home cough assist management, home TPN (Total Parenteral Nutrition), home 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, as well as nasogastric, nasojejunostomy tube, PEG (Percutaneous Endoscopic Gastrostomy) and PEJ (Percutaneous Endoscopic Jejunostomy) tube, IDC (Indwelling Catheter) and SPC (Suprapubic Catheter) management at home. We also provide palliative care services at home.

 

Every week I speak with families from all over the world who are facing the same desperate situation. Their loved one is in ICU. The hospital wants to either stop treatment, withdraw treatment, keep them in ICU, send them to a step-down ICU, or — if you are watching this from the U.S. — send your loved one to an LTAC (Long-Term Acute Care) facility. And all families are asking: why can we not just take care of my loved one at home?

 

Today I am going to walk you through a real conversation I had this week with a lady named Kelly, whose 58-year-old husband is currently in ICU. He is on a ventilator with a tracheostomy, on 40% oxygen, on dialysis three times a week, post-stroke, and currently fighting a Pseudomonas infection. Kelly’s question is exactly the right question: is a long-term ICU stay really the only option, or can he come home?

 

If you or your family member are in a similar situation, stay with me, because this video is for you.

 

Kelly’s Husband’s Situation

Kelly’s husband is 50 years old. He was visiting family when he had septic shock, and that septic shock caused a massive stroke. He spent over six weeks in ICU, and Kelly has been fighting very hard — with both the hospital — to get him the right care and treatment. The ICU initially said they wanted to withdraw treatment.

He is now on a ventilator with a tracheostomy, which was placed approximately two weeks ago. He is on 40% oxygen and on dialysis three times a week for acute kidney failure, which means there is a chance the kidneys may be recovering. He has developed Pseudomonas — a serious hospital-acquired bacterial infection that is very common in ICU patients on ventilators. He is also post-stroke from septic shock.

 

The ICU gave Kelly two options. One option was to withdraw treatment and let her husband die, because the ICU believed he would have no quality of life. The other option was to keep him in ICU until he might be weaned off the ventilator — but the ICU is now telling her he cannot be weaned off the ventilator.

 

Kelly started doing her research. She reached out to us here at Intensive Care at Home. She also found reports on the hospital of infections, inadequate staffing, poor communication, and patients returning to ICU on a regular basis. On top of that, she was becoming exhausted from staying in ICU almost day and night. She did what smart families in that situation do — she googled, she found us and called. Her question was: why can’t we take care of him at home with Intensive Care at Home? Smart question.

 

What Does Long-Term ICU or a Long-Term Care Facility Actually Mean As Opposed to Intensive Care at Home?

Staying in hospital, staying in ICU, or eventually going to a long-term unit sounds very clinical and medical. But in my experience, having worked in critical care nursing for over 25 years in three different countries — where I worked as a nursing manager for over five years in intensive care, and having founded Intensive Care at Home in 2012 — most long-term ICUs or long-term weaning units are nothing more than glorified step-down units that are not staffed to ICU levels.

 

The reason hospitals push for either withdrawal of treatment, long-term ICU, or transfer to long-term weaning units is often financial. Once a patient has been in ICU long enough, it becomes too expensive for hospitals to continue their care. Keep in mind an ICU bed costs between $5,000 to $10,000 per bed day. The hospital then needs to move the patient somewhere. Step-down ICUs and long-term weaning units become the next step — but not because those places are the best clinical option for your loved one.

 

Here is what families in intensive care often discover, whether their loved one is in long-term ICU, a step-down ICU, or a long-term weaning unit:

• Staffing ratios are not at ICU level
• Hospital-acquired infection rates can be very high, including Pseudomonas and other resistant organisms
• Communication with families is often poor
• Patients frequently deteriorate and are transferred back to the ICU, sometimes repeatedly
• Families stay in ICU day and night, which affects both family psychological and mental health, and the patient’s psychological and mental well-being

The system is designed to move costs, not necessarily to optimize patient and family outcomes. That is why, if home care is clinically feasible and safe, it is almost always a better option than staying in ICU long-term, going to a step-down ICU long-term, or going to a long-term weaning unit.

 

Can Kelly’s Husband Come Home?

Let me walk you through exactly what I assess when a family like Kelly’s calls me. The assessment process is underpinned by our evidence-based Mechanical Home Ventilation Guidelines which you can find on our website at intensivecareathome.com.

 

Oxygen requirements: 40% oxygen is not very high for a ventilated patient. Many patients we take home are on supplemental oxygen, but the oxygen percentage alone is only one piece of the picture. What I need to see are the full ventilation settings. What mode is he on? What is the PEEP (Positive End-Expiratory Pressure)? What is his respiratory rate? What is the pressure support? Can he initiate his own breaths? Those details tell me how much breathing work he is doing himself.

 

Dialysis: Dialysis is not a barrier to home care. We can send patients to an outpatient dialysis clinic or we can facilitate dialysis at home — for example, if it is PD (Peritoneal Dialysis). The question is whether we can coordinate the dialysis schedule with the nursing care plan and the patient’s location. That is a logistics challenge, not a clinical barrier.

 

Pseudomonas infection: Pseudomonas aeruginosa is a gram-negative organism that thrives in ICU environments, particularly in patients who have been on a ventilator for a prolonged period. It is a serious infection and needs to be treated properly. But Pseudomonas is not automatically a reason to keep a patient in hospital indefinitely. What I want to know is: is the infection being treated with the right IV antibiotics? Is the patient responding? Are the inflammatory markers such as CRP (C-Reactive Protein) and white cell count) trending down? If the answer is yes, we can plan home discharge even while completing an IV antibiotic course.

 

Post-stroke neurological status: A stroke adds complexity. I need to know the degree of neurological impairment. Can he follow commands? What is his LOC (Level of Consciousness)? Is there significant motor weakness? Are there any seizure concerns? The tracheostomy addresses some of the airway issues, but I still need the full neurological picture.

 

The detail is everything — the devil is in the detail.

 

Other things that can affect home discharge feasibility include whether the patient needs regular blood transfusions, whether they are haemodynamically unstable, and whether there are other organ systems that are not yet stabilized.

This is why I asked Kelly to send me a medical record summary — not all of the records, just a clear summary of where things stand clinically right now. That summary gives me enough to do a proper assessment and give Kelly an honest answer about what is possible.

 

How to Access Medical Records and What We Need

If your loved one is in ICU and you are thinking about home care, you need to access their medical records. This is non-negotiable. As the spouse, as the next of kin, or as the medical POA (Power of Attorney), you have every right to access your loved one’s medical records. In Kelly’s case, she already has access, which is excellent.

Here is what we need in a medical record summary for a home ventilator assessment:

• Current diagnosis and reason for ICU admission
• Current ventilator settings: mode, FiO2 (Fraction of Inspired Oxygen), PEEP, respiratory rate, tidal volume, pressure support
• Current medications: vasopressors, inotropes, sedation, antibiotics, anticoagulation
• Current observations: oxygen saturations, heart rate, blood pressure, temperature
• Recent blood results: inflammatory markers, kidney function, hemoglobin
• Active infections and treatment plan, including any planned procedures or surgeries
• Neurological status and LOC

You do not need to send hundreds of pages. A clear summary or a few key pages from the chart is enough to begin with.

 

Who We Are

Intensive Care at Home is currently operating all around Australia, in all major capital cities, in all regional and rural areas, in all states and territories. We are the only third-party Intensive Care at Home nursing service that is third-party accredited. We hold ISO 9001:2015 accreditation and we are accredited by the NDIS (National Disability Insurance Scheme) Quality and Safety Commission. We have over 150 critical care registered nurses operating across Victoria, New South Wales, Queensland, and the ACT (Australian Capital Territory).

When you are choosing who to trust with your loved one’s care at home, accreditation is not a minor detail — it is everything.

We also receive enquiries from families in the United States, the United Kingdom, Europe, Canada, and the Middle East. People also find us through our intensivecarehotline.com website, where we provide clinical consulting and advocacy for families in intensive care all around the world.

 

What You Need to Do Right Now

1. Get access to your loved one’s medical records through the patient portal or by requesting copies from the ICU.

2. Do not accept what the ICU tells you — that your loved one needs to stay long-term, needs to go to a step-down ICU, or needs to go to a long-term weaning unit — as if that were the only option, without exploring home care with Intensive Care at Home first. Ask the ICU team directly: what would need to happen for this patient to go home on a ventilator?

3. Talk to us about funding. We know how to access funding for patients — otherwise we would not exist.

4. Contact us at http://intensivecareathome.com, send a medical record summary, and let me and my team assess what is possible.

Kelly, and anyone watching this: you are asking exactly the right questions. You are your husband’s best advocate. Do not let the system make that decision for you. And for everyone else watching, if your loved one is in ICU right now, and you are wondering what is possible, reach out to us, that is what we’re here for.

My name is Patrik Hutzel. Thank you so much for watching and if this video helped you, share it with anyone who needs it, like, comment, subscribe if you have not done so already and I will see you in the next one.

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.