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“Taking your loved one home on (BIPAP) Bilevel Positive Airway Pressure or ventilator from ICU: Step-by-step guide.”

My name is Patrik Hutzel from intensivecareathome.com, where we provide tailor-made solutions for long-term ventilated adults and children with tracheostomies for BIPAP and CPAP (Continuous Positive Airway Pressure) ventilated adults and children without a tracheostomy, tracheostomy without ventilation, cough assist management at home, ventilation weaning management at home, Home TPN (Total Parenteral Nutrition), home IV potassium, home IV magnesium, IV fluids and IV antibiotic infusions at home, which includes central line, PICC (Peripherally Inserted Central Catheter) line, Hickman’s line, port-a-cath management at home, nasogastric tube, nasojejunostomy tube, PEG (Percutaneous Endoscopic Gastrostomy) tube, PEJ (Percutaneous Endoscopic Jejunostomy) tube management at home, as well as IDC (indwelling urinary catheter) and SPC (suprapubic catheter) management at home, including palliative care.

So today, I have a question from Maria, who says:

“Hi Patrik,

My mom is in ICU. She came in because she had pneumonia due to liver failure. Supposedly they treated the pneumonia, now her CO2 (carbon dioxide) is way higher. Before all of this, her CO2 (carbon dioxide) was normal. They put her on BIPAP, but it is still not working, it’s actually getting worse.

I would like for you to take care of my mom at home. She has private health insurance, can you please help us to take her home before it’s too late? Thank you.

From, Maria.”

Now Maria, thank you so much for your question about your mom. I can hear the urgency in your message and I understand you want to get your mom home where she can receive personalized and holistic care, and where she’s not just a number. Let me walk you through the exact steps you need to take to make this happen.

Before we talk about taking your mom home on ventilation, let’s quickly address what’s happening. Your mom came into ICU with hepatic encephalopathy, ammonia build-up from liver failure, and now she’s developed hypercapnia, which is high CO2 levels. The BIPAP isn’t working effectively, which means her respiratory failure is worsening. This is exactly the type of situation where families need to consider alternatives to long-term hospital and ICU care, and mechanical ventilation with Intensive Care at Home can be a life-saving, personalized and holistic option.

So, can you take someone home on BIPAP or a ventilator? Absolutely yes. According to our evidence-based Mechanical Home Ventilation Guidelines that we follow strictly at intensivecareathome.com, and that you can find on our website, patients can be safely managed at home on non-invasive ventilation like BIPAP or CPAP, or mechanical ventilation via tracheostomy, as long as there are 24-hour critical care and intensive care nurses similar to an ICU. These evidence-based Mechanical Home Ventilation Guidelines clearly show that home mechanical ventilation is not only possible, but often provides better outcomes than extended ICU stays, especially for patients with chronic respiratory failure.

1. Get a proper assessment and diagnosis.

You need to understand exactly why your mom’s CO2 is rising and the BIPAP isn’t working. The key questions are:

• Is this acute or chronic respiratory failure?
• Does she have an underlying condition like COPD (Chronic Obstructive Pulmonary Disease), asthma, or neuromuscular disease?
• Is the liver failure causing respiratory muscle weakness?
• Is the BIPAP properly titrated with the right settings?
• Does she have pneumonia? Does she have pulmonary edema, which is water on her lungs?

You’ll need the ICU team to document her diagnosis and ventilation requirements clearly.

2. Request a family meeting and discuss home ventilation with Intensive Care at Home.

This is critical, Maria. You need to request a formal family meeting with the ICU consultant or intensivist, the respiratory physician, the ICU social worker or discharge planner, and a home ventilation specialist, like we are at Intensive Care at Home.

At this meeting, you need to clearly state: we want to explore taking mom home on mechanical ventilation with Intensive Care at Home, whether she needs non-invasive BIPAP or CPAP, or with a tracheostomy if needed. Many ICU teams don’t automatically think about this option, so you need to put it on the table.

3. Determine if your mom needs non-invasive or invasive ventilation.

So, non-invasive ventilation, BIPAP at home works if your mom can protect her own airway, she can clear secretions effectively, she doesn’t need continuous ventilation, can breathe some of the time on her own, she’s cooperative and can tolerate the mask, CO2 levels improve with properly adjusted settings, and she’s not a high aspiration risk.

Invasive ventilation with a tracheostomy is needed if she requires 24-hour ventilation support, she cannot protect her airway, she has excessive secretions, BIPAP has failed despite optimal settings, she needs prolonged ventilation more than 2 to 4 weeks.

Given that your mom’s BIPAP is not working and is actually getting worse, she may need a tracheostomy for invasive mechanical ventilation, including going home with Intensive Care at Home.  Don’t be afraid of this option. It might be temporary and it might be the right next step she needs to take because many patients thrive at home with tracheostomies in a personalized and holistic home care environment where your family member is not just a number, like they are in a hospital.

This is where also private health insurance becomes your best friend, Maria. With private health insurance you have options that general Medicare patients often don’t have. You need referrals to a home ventilation company like ours, Intensive Care at Home, that provides home ventilators, whether it’s invasive or non-invasive, CPAP, BIPAP machines, oxygen concentrators, backup ventilators, at least two suction machines, home care monitors, all supplies, circuits, masks, tracheostomy supplies, etc. where we can provide at Intensive Care at Home, critical care trained nurses in ventilation management, respiratory physicians, 24/7 intensive care nurses at home similar to an ICU so that there’s no gaps in care.

We provide care coordination, and we are the only service provider in 2026, now by the time I’m recording this, that is third-party accredited for Intensive Care at Home nursing. There’s no other service provider in Australia that has achieved third-party independent accreditation for Intensive Care at Home nursing. We have the intellectual property, we have created the intellectual property, we have created the policies, procedures, we have the know-how, and the team, which includes hundreds of years of intensive care and nursing experience combined to make it all happen. We have our own intensive care consultant that is managing our clients on a medical basis whenever it’s appropriate.

With private health insurance, you need to contact your insurance company immediately, ask specifically about coverage for your mom, including the equipment, and ask about coverage for intensive care nurses at home or private duty nursing. Get pre-authorization for home ventilation equipment, get authorization for 24-hour intensive care nurses at home.

Most private health insurance plans cover the home care, because it is significantly less expensive than keeping someone in ICU long-term. An ICU bed costs $5,000 to $10,000 per bed day, depending on the location and the diagnosis of the patient. Intensive Care at Home is approximately 50% of the cost and can provide a personalized, holistic, and family-friendly care environment. The evidence shows that home care costs, like I said, it’s about 50% of what the ICU care costs.

Let’s look at home safety assessment and setup. Before your mom can come home, you need a home safety assessment by our home care team, adequate electrical supply for ventilators and beds and suction machines and so forth, backup power source, generator or battery backup, adequate space for equipment, emergency action plan posted visibly, contact numbers for equipment company, and where to get all the equipment from. But again, we know where to get the equipment from.

Coordinate the discharge plan, work with ICU discharge planner to coordinate discharge date and time, medical transport with ventilator capabilities if needed, all medications and prescriptions, follow-up appointments with pulmonologists and other specialists. Obviously we provide the roster, equipment delivery and setup before discharge.

It’s non-negotiable that you need 24-hour intensive care nurses at home, and with her private insurance, this should be covered. Don’t let anyone tell you she only needs a few hours a day, or don’t let anybody tell you she can’t go home. Someone on invasive or non-invasive mechanical ventilation needs continuous 24-hour intensive care nurses similar to an ICU.

This is what we do at Intensive Care at Home, this is what we live and breathe. Since you asked specifically about our services, Maria, here’s how we help families in your exact situation. We provide 24/7 critical care and intensive care nurses at home who are all experienced in invasive and non-invasive ventilation with or without a tracheostomy. We coordinate with respiratory physicians, intensivists. We manage, like I said, both non-invasive and invasive ventilation. We manage tracheostomies. We work with all major private health insurance companies. We provide 24-hour nursing care or whatever level of support your family needs, and we handle all the coordination with equipment, doctors, hospital discharges, and so forth.

We’ve helped hundreds of families get their loved ones home from ICU on ventilation, and we’ve seen remarkable improvements once our clients get into the comfort of their own home with personalized, holistic and family-friendly care. And again, we follow best care, which is best evidence, which is the Mechanical Home Ventilation Guidelines on our website. They’re evidence-based and they show improved quality of life compared to ICU, lower infection rates because you’re in a clean environment at home, better patient satisfaction and emotional wellbeing, better family satisfaction and emotional wellbeing, cost effectiveness compared to long-term ICU, and comparable or better survival rates for appropriate candidates.

Your mom fits the profile, especially if her high CO2 and respiratory failure become chronic issues related to her liver disease. You’re absolutely correct when you’re saying you need help before it’s too late. If your mom’s CO2 is climbing despite BIPAP, and she’s getting worse, the ICU team needs to either adjust her ventilation strategy, different settings, different interface, consider intubation and tracheostomy, address underlying causes, liver failure management, fluid status, nutrition.

Sitting and watching her deteriorate is not an option. You have the right to advocate for either better treatment in ICU or transition to home care with appropriate ventilation support. Every day in ICU increases the risk of hospital-acquired infections, ICU delirium and cognitive decline, muscle wastage and weakness, pressure injuries, depression and anxiety, and of course caregiver stress.

Let’s also look at some of the real or perceived roadblocks and how to overcome them:

1. One roadblock can be that the hospital says, “She’s too sick to go home.”

Ask specifically what medical criteria she must meet from the hospital’s perspective. With 24-hour accredited intensive care nursing and respiratory support at home, the bar is much different than if she were going home with family care alone.

Roadblock number 2, insurance won’t approve it. Have the doctor write a letter of medical necessity, get a peer-to-peer review with the insurance medical director, and appeal if necessary. We help families with this process.

Roadblock number 3, which is not really a roadblock, but I’ve heard it, which is why I bring it up, “We can’t find nurses who can handle ventilators.” Well, that’s exactly our area of expertise. We exclusively hire nurses who are familiar with ventilators and tracheostomy because they’re critical care trained nurses. It’s exactly what we specialize in with Intensive Care at Home. We specifically recruit and train critical care nurses for these situations only.

Roadblock number 4, equipment is too complicated. Again, modern home ventilators are actually more user-friendly than hospital ICU ventilators, plus you’ll have trained nurses managing the equipment 24/7.

Your instinct is to get your mom out of ICU into a home care environment, and you are spot on. The evidence supports it, the technology exists, you have the insurance to cover it, and your mom’s condition is exactly what home mechanical ventilation was designed for. Your mom doesn’t need to deteriorate in an ICU. She can receive excellent, personalized, holistic and family-friendly care at home with the right Intensive Care at Home team in place.

So, 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 a long-term stay in intensive care for ventilation, tracheostomy, home BIPAP (Bilevel Positive Airway Pressure), home CPAP (Continuous Positive Airway Pressure), ventilation without tracheostomy and tracheostomy care without ventilation, Home TPN (Total Parenteral Nutrition), home IV potassium, home IV magnesium, home IV antibiotic, and 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. We’re also providing nasogastric tube, nasojejunostomy tube, PEG, PEJ tube management at home, as well as IDC (indwelling urinary catheter) and SPC (suprapubic catheter) 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 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.

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 (National Disability Insurance Scheme) approved service provider all around Australia, TAC (Transport Accident Commission) and WorkSafe in Victoria, as well as the Department of Veteran 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’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 go from our first case study to advocate successfully for funding 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, who are 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.

Plenty of examples where clients with support worker models or even RN models without ICU experience have died at home and 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, and 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, and 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. An 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 bed 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, if not most of our cases.

This is also why we are providing 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.

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, in Albury, Wodonga, in Bendigo, in Geelong, in Warragul, and also in Wyelangta in Victoria. If you have worked in critical care nursing for a minimum of 2 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 a tailor-made solutions for our clients which includes regular staff. Our clients also do 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.

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 take the pressure off your ICU and ED beds, and 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. 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 (Emergency Department) beds.

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 with hiring nurses privately.

Once again, our website is intensivecareathome.com, call us on one of the numbers on the top of our websit,e 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.