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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 at home with tracheostomies with 24/7 ICU (Intensive Care Unit) nurses, where we provide tailor-made solutions at home for long-term ventilated adults and children on BiPAP (Bilevel Positive Airway Pressure), CPAP (Continuous Positive Airway Pressure) ventilation without tracheostomy with 24-hour ICU nurses, where we provide tailor-made solutions for adults and children with tracheostomies at home without ventilation with 24-hour ICU nurses.

 

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, IV potassium, magnesium and other electrolyte infusions, central line, PICC (Peripherally Inserted Central Catheter) line, Hickman’s line, as well as port management at home, IDC (Indwelling Catheter), SPC (Suprapubic Catheter), nasogastric tube, nasojejunostomy tube, PEG (Percutaneous Endoscopic Gastrostomy) and PEJ (Percutaneous Endoscopic Jejunostomy) 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) and WorkSafe case management.

 

In today’s blog post, I want to walk you through what a seizure emergency at home can look like for someone on BiPAP. Our critical care registered nurses are trained for exactly this kind of situation. And it answers a question I get asked by families, NDIS support coordinators and lawyers almost every week. It goes like this: “Patrik, the NDIA (National Disability Insurance Agency) says a delegated model of care with support workers is enough. Why do we need 24/7 critical care registered nurses?”

 

Stay tuned, because I will walk you through this step by step today.

 

And if you need help right now, if your loved one is at risk of a seizure, breathing or airway emergency at home, and the NDIS is pushing a delegated model of care instead of 24/7 critical care registered nurses, talk to us today. Call us on one of the numbers on the top of our website at intensivecareathome.com, or book a call with me through the schedule appointment button, or call me directly on 041 094 2230. We work with NDIS, TAC, WorkSafe, DVA (Department of Veterans’ Affairs) and private clients all around Australia, in all states and territories. And also go and grab the free download, the 24/7 CCRN (Critical Care Registered Nurse) Safety Checklist: 12 Questions to Ask Before You Accept a Delegated Model of Care. You can click on the link.

 

So what is a delegated model of care under the NDIS? A delegated model of care is where a registered nurse assesses a participant, writes a care plan, trains support workers, and then delegates clinical tasks to those support workers. The nurse usually isn’t in the home. They supervise from a distance and visit periodically. They probably don’t even know the patient that well.

 

For many NDIS participants, that model can work, but for most it doesn’t, and I want to be clear about that. I have enormous respect for the support workers doing this work every day. But for people living with BiPAP or CPAP, a tracheostomy, invasive ventilation, non-invasive ventilation, or complex seizures with airway risks, the question isn’t, “Can a task be delegated?” The question is, “Who’s in the room when the plan stops working?”

 

So what can a seizure emergency at home on BiPAP look like? Picture a person living with severe epilepsy and complex disabilities. They use BiPAP. They’re fed through a PEG tube. They can’t clear their own airway or take off their own BiPAP mask. This is a typical picture of what our CCRNs are trained to manage. That’s the training they had in ICU, of course, and also the training and experience they have with our clients. It’s a general scenario, not one person’s story, because it’s so common.

 

The first few minutes: this isn’t the usual pattern. Many people with complex epilepsy have drops that the family and the team know very well. Often these are atonic drops, a sudden loss of muscle tone. Now imagine the episodes look different. The body suddenly goes stiff, tonic. Breathing pauses for a few seconds. The pupils dilate, and the color turns gray. Then the person comes back, and then it happens again.

 

To an untrained eye, these can look like the usual drops. To an ICU nurse, a change in seizure pattern is a red flag that the episodes may be building towards something bigger.

 

The next 10 minutes: escalating before it’s too late. The ICU nurse gives the first prescribed medication according to the person’s seizure plan. If the episodes keep coming, the nurse has to decide whether to give rescue medication early, before a generalized seizure takes hold. That’s a clinical judgment, not a tick box.

If it becomes a generalized seizure: airway, oxygen, BiPAP. Sometimes, despite everything, it progresses into a fully generalized grand mal seizure: unresponsive, stiff, breathing shallow and irregular. In that situation, a CCRN will typically:

• Position the person safely and give further rescue medication if the plan allows.
• Apply oxygen and the pulse oximeter straight away, because oxygen levels can fall into the 80s quickly.
• Suction frequently from the back of the mouth to protect the airway.
• Get the person onto BiPAP with oxygen added to the circuit.
• Assess the airway, including a clenched jaw and whether a jaw thrust is needed.
• Titrate the oxygen down as the person recovers, rather than leaving it on high.

 

Once the seizure stops, the work isn’t over. Seizure medications can slow breathing and heart rate, so the nurse stays at the bedside, monitors closely, and keeps BiPAP on until the person can maintain their own oxygen levels. When all of that is done well, the aim is clear: no ambulance, no emergency department, no ICU, and the person recovers in their own bed.

 

So why couldn’t a delegated model of care manage this seizure emergency? Let me be fair here. A well-trained support worker can be trained to give a rescue seizure medication following an epilepsy management plan. That’s true. But look at what that half hour actually involves. Almost none of it is following a plan. It’s clinical judgment, minute by minute and sometimes second by second.

 

Recognizing the change from atonic to tonic seizures. A plan says “usual drops are expected.” Someone has to know these aren’t usual.

 

Deciding to escalate early, before a generalized seizure takes hold. These are all clinical judgments that a disability support worker is simply not trained, and can never be trained, for.

 

Next, managing the unstable airway in an unconscious, seizing person with a clenched jaw and pooling secretions, and assessing for a jaw thrust.

Next, titrating oxygen to saturation and entraining oxygen into a BiPAP circuit mid-emergency.

Next, interpreting the observations: pupils, nystagmus, heart rate, respiratory pattern, and knowing whether the person is getting better or worse.

Next, post-seizure monitoring of a slowed heart rate and breathing after sedating medications.

 

In a delegated model of care, what does the plan almost always say? “If the seizure lasts more than 5 minutes, call triple zero (000).” And that’s the right instruction for a disability support worker, because it’s outside of their scope of practice to manage what comes next.

 

So let’s be clear about the most likely outcome, in my clinical opinion, after having worked for over 25 years in intensive care and critical care nursing, where I worked as a nurse manager for over 5 years in intensive care. I started Intensive Care at Home in 2012 here in Australia. That’s how long we’ve been operating for. But I also had firsthand experience pioneering the Intensive Care at Home model in Germany in the early 2000s.

 

And with all my experience, I can tell you that without a CCRN present, a seizure emergency like this would very likely end with an ambulance call, an emergency department admission, and quite possibly an ICU admission. While waiting for paramedics, the person could be seizing with falling oxygen levels, a clenched jaw and secretions at the back of the throat. That is exactly the scenario where aspiration, hypoxia and cardiac arrest happen. In the worst case, it can be fatal.

A delegated model of care is basically like flying an airplane with the cabin crew instead of a pilot. Whereas we are the pilot, because we have all the clinical expertise, the knowledge, the registration and so forth, so we know what to do. You should never fly the airplane with the cabin crew instead of the pilot, because it should always be the pilot. Our pilots in the cockpit are the ICU nurses, 24 hours a day. So the analogy fits perfectly.

 

Again, you don’t put a cabin crew member in the cockpit and say, “We’ve given you a checklist. Call the tower if anything goes wrong.” Most of the flight is uneventful. The pilot is there for the moments that aren’t.

 

So what happened to Noah Johnston, and what does he teach us? Many of you know the case of Noah Johnston, a young man I’ve spoken about publicly before. In December 2025, Noah’s tracheostomy tube became displaced at a time when there was no registered nurse in the home. Noah sadly, but also predictably, passed away.

 

A displaced tracheostomy tube and a prolonged seizure are different emergencies, but they have the same thing in common. They come without warning. The first few minutes decide the outcome, sometimes the first few seconds. When a CCRN with ICU training is in the room, those minutes are managed. When there isn’t one, families are left waiting for an ambulance, or sometimes they can’t even wait for an ambulance, because patients pass away right there and then. That’s how urgent these situations are, and that’s how time-sensitive those situations are. That’s the difference this whole debate is really about.

 

And Noah Johnston’s case has been in the media more than once, in January this year, 2026.

 

So what do the evidence-based mechanical home ventilation guidelines say? Because all of what I’ve been saying so far is not just my opinion. It’s actually evidence-based. When you look on our website at intensivecareathome.com, our evidence-based Mechanical Home Ventilation Guidelines, based on international guidelines including the German S2 guidelines on non-invasive and invasive ventilation, set out that:

 

Number one, home ventilation, including non-invasive ventilation like BiPAP, must be delivered by 24/7 critical care trained nursing staff.

Number two, the day-to-day nursing team must be registered nurses with a minimum of 18 months intensive care or critical care nursing experience. We have even increased that standard to a minimum of 2 years. As a matter of fact, the average nurse on our books probably has 8 to 10 years ICU experience. And also, we employ hundreds of years of critical care and ICU nursing experience combined. No other service provider in Australia brings a higher skill level into the community than we do.

 

And service delivery without critical care trained nurses puts ventilated adults and children at risk of death and increases the burden on families.

 

For people with neuromuscular weakness and cough insufficiency, a drop in oxygen saturation can be an early sign of secretion retention, which is exactly why a CCRN puts a saturation probe on, or reads it, within seconds. Most of our clients have it attached anyway, if they choose to.

 

So let’s now also look at why accreditation matters for Intensive Care at Home. Intensive Care at Home is, to my knowledge, in 2026 the only third-party accredited Intensive Care at Home nursing service in Australia, accredited specifically for the delivery of intensive care nursing services at home, including services to ventilated patients, under a quality management system based on ISO (International Organization for Standardization) 9001:2015. And we are also a registered NDIS provider. You can view our certificates at intensivecareathome.com/accreditation-quality.

 

Accreditation means our processes for situations like this, escalation, airway management, oxygen, documentation and incident review, are independently audited, not just written down.

 

So how do you use an incident like this as NDIS evidence? Here’s something families often miss. Incident reports and observation charts from your own loved one’s care are powerful evidence for an NDIS plan review, an ART (Administrative Review Tribunal) appeal, or a TAC or WorkSafe funding decision. They show how often unpredictable, high-risk events happen, which interventions were clinical and could not have been delegated, when a hospital admission was avoided, and what that saved the system.

 

So ask your provider for incident reports, seizure charts and observation records, and ask your NDIS support coordinator to put them in front of the NDIA. If they’re funding 24/7 CCRN care, keep building that evidence base. And again, grab our free 24/7 CCRN Safety Checklist: 12 Questions to Ask Before You Accept a Delegated Model of Care. Take it to your next planning meeting.

 

So how can we help at Intensive Care at Home? We provide 24/7 critical care registered nurses at home for people on invasive ventilation with tracheostomy, non-invasive ventilation without tracheostomy, and tracheostomy without ventilation. And obviously, we provide complex care and seizure management with airway risk, TPN, central line, PICC line, Hickman’s line, port management, etc. Since 2012, we’ve kept people out of ICU and in their own homes, predictably and permanently, at roughly half of the cost of an ICU bed.

 

So again, we employ hundreds of years of critical care nursing experience combined in the community, enabling us to look after the highest acuity clients in the community safely with Intensive Care at Home, with our awesome and amazing critical care nursing workforce. Once again, we’re NDIS registered, and we work with TAC, WorkSafe and DVA. We provide Level 2 and Level 3 NDIS support coordination to help build your evidence and plan.

 

Talk to us today. If your loved one is at risk of a seizure, breathing or airway emergency at home, and the NDIS is pushing a delegated model of care instead of 24/7 critical care registered nurses, talk to us today. Call us on one of the numbers on the top of our website at intensivecareathome.com. Book a call with me at intensivecareathome.com by clicking the schedule appointment button, or send me an email to [email protected].

 

If you’re watching this and you’re overseas, in the US, in Canada, in the UK, in India or anywhere overseas, please contact us as well. We can help you there and point you in the right direction.

 

So, frequently asked questions coming out of today.

 

What is a delegated model of care under the NDIS? A registered nurse assesses the participant, writes the care plan and trains support workers, who can then carry out delegated tasks without a nurse present. The RN (Registered Nurse) supervises remotely and visits periodically. I urge any RN that is involved in a delegated model of care to make sure it’s compliant with their AHPRA (Australian Health Practitioner Regulation Agency) registration, because in some cases it might actually breach their AHPRA registration, and they could be at risk of losing their AHPRA registration.

 

Can a support worker give seizure rescue medication? Yes, they can. They can be trained to give some rescue medications under an epilepsy management plan. What they can’t do is the clinical assessment, airway management and oxygen titration that may follow if the seizure doesn’t stop. For example, if you give midazolam, a patient might stop breathing. Most disability support workers wouldn’t know that, and wouldn’t know what to do when a patient stops breathing. The patient could die if you don’t know what to do.

 

When should you call triple zero (000) for a seizure? Follow the person’s own seizure management plan. General guidance is to call an ambulance if a convulsive seizure lasts more than 5 minutes, if another starts before the person recovers, if they’re injured, if they have trouble breathing, or if it’s their first seizure.

 

Who needs 24/7 critical care registered nurses at home? In our experience: people on invasive ventilation with tracheostomy, people on non-invasive ventilation who can’t remove their own mask and protect their airway, and people with a tracheostomy without ventilation. It’s similar to an ICU. We wouldn’t use support workers in an ICU looking after ICU patients, so why would that be any different in a home care environment? Complex seizures with airway risk often fall into the same category.

 

Does the NDIS fund 24/7 nursing? It can, and it has been for a long time, when the evidence shows it is reasonable and necessary: detailed clinical evidence, incident reports, observation charts, specialist letters and hospital discharge summaries. The evidence is absolutely critical.

Is Intensive Care at Home cheaper than a hospital? In our experience, Intensive Care at Home costs roughly half of the cost of an ICU bed, and every avoided admission reduces the cost further.

 

The bottom line is this. A seizure management plan can tell you what to do in the first 5 minutes. It can’t make clinical decisions for the next 25. A 24/7 critical care registered nurse recognizes the warning signs, escalates early, protects the airway, manages oxygen and BiPAP, and gives the person the best chance of staying at home. That’s what 24/7 CCRN care with Intensive Care at Home is for. Again, contact us so we can help you at intensivecareathome.com.

This video describes a general clinical scenario for education. It is not based on any one individual. It is not individual medical advice. Always follow your treating team’s care plan, and call triple zero in an emergency.

 

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.