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My name is Patrik Hutzel from intensivecareathome.com, and here at Intensive Care at Home, we provide tailor-made solutions for long-term ventilated adults and children with tracheostomies, tailor-made solutions for long-term ventilated adults and children on BiPAP (Bilevel Positive Airway Pressure) or CPAP (Continuous Positive Airway Pressure) at home,

Home tracheostomy 24-hour care for adults and children on tracheostomy without ventilation, home ventilation weaning, home tracheostomy weaning, home cough assist management, Home TPN (Total Parenteral Nutrition), home IV potassium, home IV Magnesium, home IV fluids, home IV antibiotics infusions, central line, Peripherally Inserted Central Catheter (PICC) line, Hickman’s line, and port management at home.  We are also providing nasogastric tube, nasojejunostomy tube, percutaneous endoscopic gastrostomy (PEG)/ percutaneous endoscopic jejunostomy (PEJ) tube. Management of IDC (Indwelling Catheter) and SPC (Suprapubic Catheter) management at home, as well as palliative care management at home. We are also providing Level 2 and Level 3 National Disability Insurance Scheme (NDIS) support coordination, as well as Transport Accident Commission (TAC) case management.

 

Now, today I have a question from Shay, and it’s one I hear far too often. Here is what Shay wrote to me:

 

“Hi Patrik, 

 

My mom is currently in a step-down Intensive Care Unit (ICU). She has a tracheostomy, and she requires frequent suctioning, and she’s on 28% air. It means 28% oxygen. She was supposed to be weaned off or decannulated in January 2026, however, in a hospital where she was temporarily supposed to be receiving rehabilitation from her brain stem stroke, which she miraculously recovered from, the weaning of the ventilator process got halted because she got aspiration pneumonia. Ever since, she’s been through a lot of infections and what felt like neglect from the staff at the hospital. Our goal then and now is to bring her home. Today she’s in a step-down ICU, stable and ready for discharge with the right level of support. Can you help me with Intensive Care at Home?”

 

Shay, thank you so much for trusting me with your mom’s story and questions. Before I answer your question, you might be wondering what makes me qualified to answer questions like this. I have worked in critical care nursing for over 25 years in three different countries, where I worked as a nurse manager for over five years in intensive care. I’ve been consulting and advocating for families in intensive care since 2013, and I’m also the founder of Intensive Care at Home. I was part of setting up Intensive Care at Home successfully in Germany in the early 2000s before I brought the concept to Australia in 2012. I have decades of experience in intensive care in hospitals, as well as with intensive care at home in the community.

 

Thank you, Shay, for trusting me with your mom’s story and situation.

 

What happened to your mom?

 

An initially promising recovery from a brain stem stroke derailed by aspiration pneumonia and repeated infections in a subacute or hospital facility is unfortunately a pattern I see constantly. Let’s break down exactly what’s going on clinically, why the weaning stalled, what your options are, and how we can help you get your mother home.

 

The clinical picture

 

Let’s start with the clinical picture: tracheostomy suctioning at 28% Fraction of Inspired Oxygen (FIO2) at 5 liters per minute. Let’s unpack the numbers first, because they actually tell a reassuring story. Your mom is on 28% oxygen at 5 liters per minute via her tracheostomy. For context, room air is 21% oxygen, so 28% is a relatively low level of supplemental oxygen. That, combined with the fact she’s stable and being considered for discharge, tells me her lungs are functioning reasonably well despite everything she’s been through.

 

The frequent suctioning she needs is standard for anyone with a tracheostomy, especially after a brain stem stroke, because swallowing and airway protection reflexes are often affected. The tracheostomy bypasses the vocal cords, so secretions need to be cleared mechanically rather than coughed and swallowed the way they normally would be.

 

The real question isn’t whether she’s medically stable enough to leave an ICU bed — it sounds like she already is. The real question is whether she’s been given a genuine, well-supported pathway to get off oxygen, get decannulated, and go home. That’s a very different question, and it’s one that step-down ICUs, or even sub-acute and rehabilitation facilities, are often not equipped or resourced to answer or handle well.

 

Why did the weaning process get halted?

 

Aspiration pneumonia after a brain stem stroke is common, because brain stem strokes frequently damage the areas of the brain that coordinate swallowing, coughing, and airway protection. When aspiration pneumonia hits, it’s completely appropriate for a facility to pause active weaning. You don’t push to remove a tracheostomy or reduce oxygen support while someone is fighting an acute lung infection.

 

What’s not appropriate, and what I hear from families like yours over and over again, is when that pause turns into months of drift, repeated infections, and no clear plan to restart the weaning process once the infection clears. That’s not a clinical necessity — that’s a resourcing and staffing problem. Sub-acute facilities are often staffed for slow, general rehabilitation, not for the intensive hands-on respiratory and airway care that a recently stroke-affected, tracheostomized patient actually needs. This is exactly the gap that leads to what you described as neglect — not necessarily because individual staff don’t care, but because the facility’s staffing ratios and skill mix were never designed for a patient at your mom’s level of complexity.

 

Your mom’s treatment options:

 

Based on what you’ve described, your mom has three broad pathways in front of her:

 

1. Stay in a step-down ICU and hope the weaning process restarts, with no guarantee of consistent attention, let alone skilled attention.
2. Move to another institutional setting, which usually means more time in unfamiliar environments and more exposure to hospital-acquired infection, again with no guarantee of consistent skilled attention.
3. Go home with dedicated, skilled critical care nursing support at home that continues the weaning process safely — suctioning, oxygen titration, and moving towards eventual decannulation planning — in your mom’s own home.

Tracheostomy and ventilation weaning does not have to happen inside an ICU, inside a hospital, or inside a sub-acute or rehab facility. It is absolutely achievable at home when it’s supported by 24-hour critical care nurses who have ICU-level airway and respiratory skills, working from a clear, evidence-based protocol. This is precisely why I put together our evidence-based mechanical home ventilation guidelines, which you can read on our website at intensivecareathome.com. These give families and clinicians a clear, structured framework for weaning oxygen, suctioning frequency, and decannulation readiness outside of a hospital setting. You can read the full guidelines by clicking the link in the show notes.

 

Medical records: your most powerful advocacy tool

 

Here’s something I tell every family in your position: request your mom’s complete medical records. Every progress note from doctors and nurses. Every respiratory and ventilation note. Every infection control report. Every ventilation chart. Every vital sign chart. Every lab result. Every medication chart. All fluid balance charts. All specialist reports. All X-ray reports, CT (Computed Tomography), and MRI (Magnetic Resonance Imaging) scans. Not a summary — the full records. Leave no stone unturned.

 

Why does this matter so much? Because the full record will tell you exactly why the weaning was halted, exactly what caused the aspiration pneumonia, whether there were missed signs of infection, and whether the plan to restart weaning was ever actually documented or just quietly dropped. Families in intensive care or in hospitals are entitled to this information, and it’s the single most effective tool you have to advocate for your mom, to challenge any facility that tells you she’s not ready without evidence, and to build a genuine discharge plan instead of accepting institutional care by default.

 

If you’re not sure how to interpret what’s in those records — ventilator or oxygen settings, suctioning frequency, infection markers, lab results, swallowing assessments — that’s exactly the kind of thing we help families work through. We also offer independent consulting for families navigating exactly this kind of situation in intensive care. As part of the discharge process, we can review the medical records, explain what the clinical picture actually means, and help you ask the right questions of her treating team, wherever in the world you are. If that’s of use to you, you can reach out at intensivecareathome.com.

 

Why Intensive Care at Home?

 

This is exactly the situation Intensive Care at Home was built to close the gap on: a family member who’s medically stable but stuck in an institutional setting because no facility will commit to continuing tracheostomy or ventilation weaning.

 

We are proud to say that we are Australia’s only third-party and NDIS-registered intensive care at home nursing service specifically for intensive care at home nursing. We are independently audited against International Organization for Standardization (ISO) 9001:2015 standards, as well as against NDIS registration standards. You can read more about our accreditation and quality standards at intensivecareathome.com. You can find the link in the show notes.

 

If you’re outside of Australia, that accreditation is still worth knowing about — it’s a good benchmark for the kind of standards to look for and ask about when vetting any home ICU nursing provider wherever you are. I know they are very difficult to find. We constantly have enquiries from the United States, Canada, the United Kingdom, and other parts of the world, so I encourage you to reach out anyway, because we can help guide you in the right direction in other countries too.

 

In Australia, we operate in all states and territories, in all regional and rural areas as well as in all metro areas. We employ hundreds of years of combined critical care nursing experience, which enables us to look after the highest-acuity clients in the community safely.

 

The bottom line, Shay, is this: your mom’s story — a stroke recovery derailed by aspiration pneumonia, then stuck in limbo in a subacute facility — is more common than most families realize, and it is not a dead end. Being stable and ready for discharge in a step-down ICU is genuinely good news. The next step is making sure discharge doesn’t just mean another institution, but a real plan to get her home safely and predictably, get the tracheostomy out when she’s ready, and get her off oxygen for good. Start by getting those full medical records, understand exactly what’s happening and why, and don’t accept “she’s not ready” as an answer without the evidence to back it up.

 

Next steps

 

Call one of the numbers at the top of our website at intensivecareathome.com, or book a call with me — there’s a schedule appointment button on the website — or send me an email at http://intensivecareathome.com. You can also call me on my mobile phone number directly: 0410 942 230. Email us at [email protected].

 

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, Naso jejunostomy 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.