Podcast: Play in new window | Download

If you want to know what’s best for your mother in intensive care after about 10 days with UTI (Urinary tract infection), ARDS (Acute respiratory distress syndrome),  and pneumonia, whether she should be moved towards palliative care and end of life care, or whether you should consider tracheostomy in Intensive Care at Home, stay tuned! I’ve got news for you.

My name is Patrik Hutzel from intensivecareathome.com, and today I have an email from Jonathan who says,

“Hi Patrik,

My mother has been in ICU for about 10 days since January 20th, 2025, with ARDS, which stands for acute respiratory distress syndrome, also known as lung failure. She was treated with antibiotics for UTI, blood infection, and pneumonia. She’s been on the ventilator from the first day with low oxygen levels and high CO2, which stands for carbon dioxide. She’s comorbid with two stage 4 pressure ulcers on her back. She’s got dementia and third space fluid buildup in several locations.

The ICU team does breathing tests each day to extubate but hasn’t seen a good response. About 5 days ago, she went for 8 hours breathing, next day, 6 hours and past few days are less than a minute before going back to assisted ventilation breathing.

She’s awake, eyes open, not appearing in pain. Blood pressure, pulse, and oxygen are low and testing has somewhat stabilized electrolytes, but full blood count results indicate weak hemoglobin levels, no plasma has been given.”

By the way, probably your mom’s albumin is low as well because low hemoglobin often goes hand in hand with low albumin levels, which then often ends up with the third space fluid buildup and swelling and your mom looks edematous.

Now the email continues,

“I am pressured daily to let her go peacefully with pain management to start before they remove the ventilator, and they say she will likely pass within hours.

The ICU doctors say risk of VAP (Ventilator-associated pneumonia) or other issues with current poor health are not surmountable and increased daily, if on the ventilator.”

VAP stands for ventilator associated pneumonia and frankly, there is a risk for anyone on a ventilator in ICU either with a breathing tube (12) or a tracheostomy. It is a risk that patients end up with a ventilator associated pneumonia or VAP, for sure. But that is like saying you don’t breathe because air might be contaminated. That is like saying you don’t eat food, or you don’t drink water because it might be contaminated. There’s always a risk in anything. In order to keep your mom alive at the moment, she needs to be ventilated.

So, the email continues,

“I’m reluctant to remove the ventilator yet in hopes she would regain the desire to inhale on her own, but they say dementia likely is causing brain signals to be weak for stimulating the diaphragm to take breaths since eyes open and she’s salivating and is responding to my touch or if I do suctioning, I know that she is still aware enough to see me, but I can’t communicate to be sure of much more.

The doctors are saying, again, the outlook is poor, and pain may exist, but we can’t tell as the tube prevents vocalizing sounds to convey this.”

Now, just as a side note here, I have worked in critical care nursing for 25 years. You can see if your mom is in pain or not, even if she can’t vocalize, you just need to pay attention to the nonverbal cues, if she’s in pain or not. It’s not rocket science.

The email continues,

“I’ve been pushing back on their wish to limit or eliminate ventilation support and terminate because of the 10-to-14-day limit. They say ventilation usually follows for a successful outcome.

Backstory, 8 months ago, she was in the same ICU 6 days on the ventilator and recovered to home care and baseline within a month. Thus, ultimately, we might win a battle, but won’t win the war, as it won’t make her live much more.

In my mind, I’m willing to hold off on the 14-day warning, so long as I see her awake and she’s interacting with me. As I’m the only child, caregiver and proxy, I will have to make decisions and be her advocate, as I’ve done for 4 years with dementia and other medical issues like pressure ulcers wound care.

It’s not going to be easy to let her go, but I’m hoping that we should proceed to a tracheostomy and then let her go home with Intensive Care at Home. I have been reading through your online materials, trying to grasp at straws of optimism for a possible turn of events, getting off the ventilator, even after 11 days on it now.

Am I backing her into a corner of suffering while resisting the doctor’s advice to go with morphine and removing ventilation support, or should I proceed with a tracheostomy, potentially a PEG (Percutaneous Endoscopic Gastrostomy) tube, and then take her home with Intensive Care at Home and see how things unfold?

I’m sure there is a lot to consider, but I am overwhelmed with the idea. I’ve been putting the rug out when she may regain the strength or brain signals to get back to breathing without the ventilator.

Thank you for all your information and your time.

From, Jonathan.”

Jonathan, two things here. The first thing is, if you remove ventilation support, put her on morphine, and you let her die, that could be perceived as euthanasia. Euthanasia, the definition is to hasten death and removing ventilation and giving her morphine is hastening death. Once again, euthanasia is still illegal. That’s number one.

Number two, if you go with a tracheostomy and ventilation, at least you’re giving her a chance and you know that being in a hospital is not conducive for your mom, especially once she has a tracheostomy at the moment, she absolutely needs to be in the hospital until you’ve made a decision. The other thing is, you know the outcome if you’re letting her die, you do know the outcome. You don’t know the outcome if you won’t let her die but at least you’re giving her a chance. Then once she’s stable, she can go home with a tracheostomy and a ventilator.

In terms of the dementia, it is really hard to say whether your mom can go back to baseline. She did go back to baseline about 8 months ago. Why can’t you go back to baseline this time around?

The other question that you need to ask them is what are they trying to do to avoid the tracheostomy and get her towards extubation because she had passed some spontaneous breathing trial. What has changed? Have they re-sedated her? So, is that why she stopped passing spontaneous breathing trials?

So, there’s a lot that needs to be looked at in a situation like that, but when it comes to Intensive Care at Home, really what you need is, use common sense. If she needs a tracheostomy, let her have a tracheostomy if that’s what you want, or if that’s what your mom wants. Ask her if she wants to live or if she wants to die. I’m sure she can answer with yes or no questions. Ask her to squeeze your hands for yes and no questions. I do believe that is possible.

A lot of our clients that we look after with Intensive Care at Home have been in very similar situations like you are, Jonathan. The intensive care team is trying to put pressure on you to end your loved one’s life. The question you need to ask yourself is, what’s the hurry to kill your mom? Are you backing her into a corner of suffering? Potentially.

These are things you need to think through, but once she’s gone, she’s gone, and there’s no return from that. You can see if she’s suffering or not. You also need to know that tracheostomy is much easier to tolerate than a breathing tube in the mouth. It’s much easier to tolerate, keep that in mind as well. So, once your mom has a tracheostomy, she probably will look much more comfortable. Keep that in mind as well.

Now, as far as in Intensive Care at Home is concerned, once you know that’s what you want, then you can confidently move towards the tracheostomy. But also, she might be able to come off the ventilator and may not ever need Intensive Care at Home, which is fine too. But, if she can’t be weaned off the ventilator and the tracheostomy, then absolutely Intensive Care at Home is the best next option.

Bear in mind that we’re cutting the cost of an intensive care bed by 50%. An ICU bed it is around $5,000 to $6,000 per bed day. With all of that said, with $5,000 to $6,000 per bed day, Intensive Care at Home is about 50% of that. Someone has an interest in paying for that because we’re cutting the cost, and you obviously have a strong interest to improve quality of life for your mom. You have a very strong interest in improving quality of life for your mom. Intensive care units need the beds to accommodate other patients, so it’s a win-win situation all around. It’s a win-win situation all around with Intensive Care at Home. So, the funding body wants to cut costs. You want your mom at home and ICUs need beds, staff, and other equipment resources.

So, with all of that said, with Intensive Care at Home, we are 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 and tracheostomy, Home BIPAP (Bilevel Positive Airway Pressure), Home CPAP (Continuous Positive Airway Pressure), ventilation without tracheostomy, tracheostomy without ventilation, Home TPN (Total Parenteral Nutrition), home IV potassium infusions, and home IV magnesium infusions. We’re also providing ventilation weaning at home. We’re also providing central line management, PICC (Peripherally Inserted Central Catheter) line management, Hickman’s line management, as well as port-a-cath management for home TPN but also for IV infusions. We’re also providing nasogastric tube and PEG tube 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. We have done so successfully as part of the Western Sydney Local Area Health District, their in-touch program, saving approximately $2,000 per patient that we keep at home, instead of going to an emergency department. We’re actively making sure that there are empty beds in an emergency department for the patients that most need to be in the emergency department.

We’re also cutting the cost of an intensive care bed by around 50%. An intensive care bed costs around $5,000 to $6,000 per bed day. Our services costs around 50% of that and we’re freeing up the most sought-after bed in the hospital, which is the intensive care bed. Most importantly, we’re improving the quality of life for patients and their families. So therefore, it’s a win-win situation for all stakeholders.

With Intensive Care at Home, we are currently operating all around Australia in all major capital cities as well as in all regional and rural areas. We’re an NDIS (National Disability Insurance Scheme) approved service provider all around Australia, TAC (Transport Accident Commission) and WorkSafe in Victoria, iCare in New South Wales, NIISQ (National Injury Insurance Scheme in Queensland), as well as the Department of Veteran Affairs all around Australia. Our clients and we, as a 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 has achieved this high level of accreditation in the community and has created more intellectual property for Intensive Care at Home nursing than we have. That 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.

Now, if you’re stuck in an ICU bed or you have a family member that is stuck in an ICU bed, especially if with ventilation and tracheostomy or if you’re at home already and you’re watching this, or if your family member is at home already and you realize that you either don’t have enough support, you realize that after absorbing all the information that you do need critical nurses, 24 hours a day, to be safe, or you realize want to go home from ICU or your family member wants to go home from ICU from a long-term stay in a hospital, then, I’ll give you a very tangible example today how we can turn your situation around for you.

One of our first clients over 10 years ago was a client who was at home on a ventilator with a tracheostomy with a support worker model 24/7. Of course, support workers cannot look after clients at home on a ventilator with a tracheostomy, full stop. That is like flying the airplane with the cabin crew instead of the pilot because anyone on a ventilator with a tracheostomy is at very high risk of medical emergencies or dying if they don’t have critical care nurses looking after them 24/7. This is actually evidence-based and is documented in the Mechanical Home Ventilation Guidelines that you can find on our website.

Think about it, in intensive care in a hospital, you wouldn’t have support workers 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?

So eventually, this client and the ICU that he was in found out about Intensive Care at Home. We were proving our concept with this client very fast because we have the solution. When we worked with the client, we sent him intensive care nurses, 24 hours a day. He never, ever went back into ICU ever again and we were proving our concept there very, very fast.

We can do the same for you if you’re not safe in the hospital or at home, that includes the advocacy for funding that goes along with it. We have always successfully advocated for our clients. Otherwise, we would not be in business.

This is also why we are providing Level 2 and Level 3 NDIS Support Coordination. We have a team of designated and dedicated NDIS Support Coordinators, and they have a wealth of knowledge. I’ve done an interview with Amanda Riches, one of our NDIS Support Coordinators, and we’ll put a link to an interview with Amanda in the written version of this blog below the video. 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 from another organization 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 what evidence to provide, I encourage you to reach out to us as well. We can 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, and high-performing team of critical care nurses in the community, we are currently employing hundreds of years of critical care nursing experience combined. If you are 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, and in Warragul in Victoria. If you have worked in critical care nursing for a minimum of 2 years pediatric ICU, ED, and you have already completed the postgraduate critical care nursing qualification, we will be delighted hearing from you.

I have a disclaimer though, because we are offering a tailor-made solution for our clients, which includes regular staff and regular teams, our clients do want the same staff coming over and over again because they are so vulnerable and so special, and that’s why we need regular staff. So, if you’re looking for agency work where you can come and go, this will not be the right fit for you. We are looking for consistency and our clients are looking for consistency. So, only apply with us if you can give us regular and consistent availabilities for shifts and only if you’re really keen on building relationships with us and with our clients, and if you think you are ready for a home care environment.

If you are 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 EDs for your long-term patients, or for your regularly readmitting patients with our critical care nursing team at home. We’re here to help you 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 much more cost-effective than what you’re paying for in ICU and ED and you get the same level of care.

If you’re a hospital executive watching this and you have bed blocks in your ICU, ED, respiratory wards, please reach out to us as well. We can help you there fast.

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 hiring private nurses.

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, 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, share the video with your friends and families, comment below on what you want to see next and what you think about this video.

Thank you so much for watching.

This is Patrik Hutzel from intensivecareathome.com and I will talk to you in a few days.

Take care for now.