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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 with tracheostomies at home with 24-hour critical care nurses, where we provide tailor-made solutions for long-term ventilated adults and children on BiPAP (Bilevel Positive Airway Pressure), CPAP (Continuous Positive Airway Pressure) without tracheostomy, where we provide tailor-made solutions for tracheostomy adults and children without ventilation at home with 24-hour critical care registered nurses, where we provide ventilation and tracheostomy weaning when medically appropriate, where we provide cough assist management, home TPN (Total Parenteral Nutrition), home IV (intravenous) fluids, home IV antibiotics, home IV potassium and magnesium, as well as 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, as well as PEG (Percutaneous Endoscopic Gastrostomy) and PEJ (Percutaneous Endoscopic Jejunostomy) tube management, 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.

 

So if your mom is on a ventilator after a spinal cord injury, she’s managed 4 hours off the ventilator, and now the hospital wants to move her to a rehab facility, is that the right move, or can she go home with Intensive Care at Home nursing instead? That’s exactly what we’re covering today.

 

So the reader asks:

 

“Hi Patrik,

 

They are mentioning putting my 71-year-old mom in an acute care rehab. She had a spinal cord injury and is paralyzed from the chest down. She was intubated and has a tracheostomy. They’re trying to wean her from the ventilator but have only had 4 hours of success with it. Your article says a long-term acute care facility should be avoided. Can we take her home with Intensive Care at Home instead? The hospital says it will provide better rehab for her.”

 

Thank you so much for your question. And before I answer today’s question, you might be wondering what makes me qualified to answer questions like the ones we’re addressing today for families in intensive care. I’ve worked in critical care nursing for over 25 years in three different countries, where I worked as a nurse manager for over 5 years in intensive care, and I’ve been consulting and advocating for families in intensive care since 2013. And I started Intensive Care at Home in 2012. That’s how long we’ve been operating. And I worked in this space also in Germany. I was part of setting up Intensive Care at Home in Germany as a pioneering service, and then I brought the concept to Australia in 2012.

 

So before we go any further, if your loved one is on a ventilator after a spinal cord injury and the hospital is talking about a rehab facility or discharge, talk to us before any decisions are locked in. Contact us at intensivecareathome.com. The numbers are on the top of the website, along with a free checklist of the questions to ask the hospital.

 

Let’s get right into it. Now, when someone is paralyzed from the waist down or from the chest down, the injury hits the nerves that control a lot of the breathing muscles. Your diaphragm, your main breathing muscle, is controlled from up in the neck. If that still works, there’s potential to breathe independently over time. But the muscles between your ribs and your tummy muscles, which you need for deep breaths and especially for coughing, are weakened or paralyzed. So secretions sit in the lungs, and that’s a setup for lung collapse and pneumonia. And at 71, there’s simply less reserve. Muscles tire faster.

 

So why is weaning so slow? The diaphragm is doing all the work on its own, and it gets tired. Secretions build up. Position matters. And here’s something many, many families don’t know: lots of people with spinal cord injuries actually breathe better lying flat than sitting up. That’s why you’ll often see an abdominal binder. Add chest infections, poor sleep, low nutrition, and in higher injuries, something called autonomic dysreflexia, where the body overreacts to things like suctioning or a full bladder, and you can see why this needs experienced critical care registered nurses 24 hours a day.

 

Now, 4 hours off the ventilator: is that good? Make no mistake, 4 hours is progress. In spinal cord injuries, weaning is measured in hours gained over weeks, sometimes months. Daytime usually comes first, nighttime last. Some people wean completely. Some stay on nighttime ventilation. Some need long-term ventilation. Nobody can promise you which group your mom will be in. But 4 hours tells you her diaphragm is working.

 

So what are the weaning options? Progressive ventilation-free breathing, or sprint weaning, where time off is gradually increased. Reducing pressure support. Cuff deflation and the speaking valve, which is huge for talking and swallowing. Cough assist and physio. Breathing muscle training. In selected patients, diaphragm pacing. And for people who can’t fully wean, long-term home ventilation is a legitimate, well-established option. Ask the team, which method are you using, and what’s the goal for the next four weeks?

 

Now to your big question: rehab facility versus long-term acute care. The reader says my article recommends avoiding long-term acute care facilities, and I have been critical of LTACs (Long-Term Acute Care facilities), a model you see a lot in the US, and of nursing home style settings for ventilated and tracheostomy patients, because staffing and ventilation expertise can be limited compared to ICU.

 

But here’s the thing. A specialist spinal cord injury rehab unit is not the same as a long-term acute care facility. Specialist spinal units see these injuries every day, and for many patients, that rehab is valuable. So the real question is, what exactly is this facility, and can it safely continue her weaning?

 

Ask: Is it a specialist spinal unit? How many ventilated patients do they have? Who manages the ventilator at 2:00 a.m.? Are the nurses critical care trained? What’s the weaning plan? How many hours of therapy a day, and what’s the plan after that? If the answers are vague, that’s a red flag.

 

So your question was also, can weaning and rehab continue at home? In many cases, yes. Home mechanical ventilation weaning is something we do, with a stable patient and medical plan, the right equipment, and critical care registered nurses at the bedside 24/7. Weaning trials can continue at home under the respiratory physician or intensivist, with physio and OT (Occupational Therapy) coming to the home or outpatient therapy, and of course with 24/7 critical care registered nurses.

 

Now, I want to be balanced here. An inpatient unit can sometimes offer more therapy hours per day. Home brings family, better sleep, less infection exposure and motivation. For some people, specialist rehab first and then a planned move home is the best combination. It is very individual.

 

Our evidence-based Mechanical Home Ventilation Guidelines spell out what must be in place: nurses with at least 18 months of ICU experience, but we have decided to choose a minimum of 2 years ICU experience; a backup ventilator and battery when ventilation is more than 16 hours a day; heated humidification; spare tracheostomy tubes; cough assist; and ongoing medical oversight.

 

Now, let’s look at funding. Here’s where families over 65 hit a wall. The NDIS in Australia only takes people who apply before 65. So for a 70-year-old, 71-year-old, you’re looking at transport accident schemes like the TAC, or iCare, or NIISQ (National Injury Insurance Scheme Queensland) if it was a road accident; WorkCover if it happened at work; DVA (Department of Veterans’ Affairs) for veterans; or aged care Support at Home, which tops out at roughly $78,000 a year. That doesn’t come close to 24/7 critical care registered nurses. In my view, that is age-based discrimination, and families should push back. And remember, 24/7 Intensive Care at Home typically costs substantially less than an ICU bed.

And also, if funding is an issue at the age of 71, you should be looking at Department of Health funding, hospital funding, private health insurance. So there are other avenues as well.

 

Let’s now look at medical records. For advocacy, information is power. Ask for: spinal cord injury level and classification, ventilator settings and weaning charts, blood gases, chest X-rays, vital capacity and cough flow, physio notes and the written transfer plan, doctor’s notes, nursing notes, vital signs, fluid balance charts, medication chart, pathology, and the list goes on. Ask for a family meeting with the intensive care specialist and the spinal team. Write down your questions, so you ask the right questions.

 

So how can we help with Intensive Care at Home? We have supported ventilated adults and children with tracheostomies at home since 2012. And we employ hundreds of years of critical care registered nursing experience combined in the community, which enables us to bring the highest skill level into the community. We operate all around Australia, in all major capital cities as well as in all regional and rural areas, basically in all states and territories.

 

And as far as I’m aware, we are the only third-party accredited Intensive Care at Home nursing service in Australia, accredited for Intensive Care at Home nursing, certified to ISO (International Organization for Standardization) 9001:2015, as well as NDIS registered. And you can check out our accreditation status on our website at intensivecareathome.com/accreditation-quality.

So why does that matter? Think of it like flying. You wouldn’t board a plane without a qualified pilot in the cockpit. A ventilated patient with a tracheostomy needs a critical care nurse 24/7 at the bedside who can act on a blocked or dislodged tracheostomy tube, a ventilator alarm, or a deteriorating chest. We’ve seen in Noah Johnston’s case, that I’ve published here many times, what can happen when no registered nurse is there. Patients unfortunately die.

 

And if you’re outside Australia, we can help you there as well. Our consulting service at intensivecarehotline.com will help you advocate with the hospital as well.

 

So here’s the bottom line. 4 hours off the ventilator is progress. A rehab facility isn’t automatically good or bad. It depends on what it is and what your mom wants. Ask the hard questions. Get the medical records. And know that going home with 24/7 critical care nursing is a genuine option for many people. You don’t have to make this decision alone.

 

Call us on one of the numbers on the top of our website at intensivecareathome.com, or book a call with me by clicking the schedule appointment button, or you can call me on my mobile phone if you’re in Australia, 041 094 2230, or you can send me an email to [email protected].

And tell me in the comments: has a hospital suggested a facility for your loved one? I read every comment. Thanks for watching, and I’ll 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.