Hi it’s Patrik Hutzel from INTENSIVE CARE AT HOME where we provide tailor made solutions for long-term ventilated Adults & Children with Tracheostomies and where we also provide tailor made solutions for hospitals and Intensive Care Units whilst providing quality services for long-term ventilated patients and medically complex patients at home.
In last week’s blog, I talked about,
You can check out last week’s blog by clicking on the link below this video:
In today’s blog post, I want to answer a question from one of our clients and the question today is
What is the Difference Between Intensive Care at Home and Intensive Care?
Just before we dive right into the topic, just a couple of notes about who am I and why am I qualified to talk about this topic? So, I am a critical care nurse with nearly 25 years, intensive care and intensive care at home experience. And after having worked in this environment for decades and after having worked with thousands of families in intensive care, and also with dozens of families in intensive care at home, I feel somewhat qualified talking about the topic, talking about the discharge process from intensive care to Intensive Care at Home. Talking about the obstacles around it, talking about perceptions in ICU, talking about perceptions in the community, but more importantly, talking about the realities in intensive care, and also talking about the realities in Intensive Care at Home.
So let’s dive right into it, what’s the difference between Intensive Care at Home and intensive care? Intensive Care at Home in English-speaking countries is a reasonably new concept. We’ve launched the concept here in Australia successfully in 2013. So we’ve been doing it for over eight years now. Prior to that, the concept of Intensive Care at Home has been established in Germany, Austria, and Switzerland. So mainly German-speaking countries in the late 1990s, early 2000s and I was part of setting it up in Germany in the early 2000 as part of a company that was pioneering this concept very successfully in Germany. And then I went off travelling as part of my critical care nursing career. Worked in the UK and Australia in intensive care.
And obviously, I was keeping an eye on what was happening in Germany in particular and Intensive Care at Home just simply exploded. And more and more patients were going home from intensive care on a ventilator with a tracheostomy, otherwise, medically complex patients in need of an intensive care nurse, went home as well. And it was a winning formula for hospitals, for health insurances, for families, and for patients of course. It creates a win-win situation.
So I then, after my travels, decided to set up a similar service here in Melbourne, Australia in 2013. Again, it was similar to my experience in Germany 20 years ago. It was very difficult. People thought this was a crazy concept. People thought this would never work. I heard people saying things like, “Oh, we don’t do Intensive Care at Home here in Australia.” Well, we are doing it now. So, don’t let anybody stop you from believing in your dreams, goals, and vision.
And obviously, a lot of it was born from my end out of frustration, really because I knew what we were doing in Germany. And I could see all these intensive care patients while I was working in ICU here that we were looking after at home and I knew that the same would be possible here. And people in ICU were mainly saying, “Oh, well. We barely do hospital in the home. That means we can’t do Intensive Care at Home.” Again, nothing could be further from the truth. We have now provided hundreds of thousands of hours of Intensive Care at Home successfully, mainly in Melbourne and in Sydney. And we continue to expand the concept and continue to expand our team, our client base. And again, we are providing win-win situations for everyone.
We are providing a holistic service for patients and families. They don’t want to be in ICU. Ask them, ask the patients, ask the families, do they want to be in ICU? The answer is no. Do they want to be at home? The answer is yes. But we are also cutting the cost of an intensive care bed by 50%. And we’re freeing up an intensive care bed that is in high need for families in intensive care.
Now I know we also have some viewers from the UK potentially Ireland, but also from the US and Canada. And I also want to quickly talk about the US and Canada specifically. We have a lot of inquiries from the US and from Canada and at this particular point in time, we are not in the US yet. However, our goal is definitely to go to the US because we have so many inquiries and we can’t serve the client population yet, but I would still give you some tips on what you can do while you are in ICU, potentially leading up to Intensive Care at Home, even though there are no specialized services in the US yet.
But there are some organizations that might be able to help you to facilitate home care. We have been in contact with a couple of organizations in the US. They’re not as specialized as we are. They’re doing a lot of other things as well. Whereas we at Intensive Care at Home, that’s all we do. We only really do discharge management from intensive care to Intensive Care at Home predominantly for long-term ventilated patients with tracheostomy, but also patients on BiPAP/CPAP ventilation, such as non-invasive ventilation.
Potentially, medically complex patients, such as seizure management at home, where airways are often compromised, cough assist management. Home TPN is a growing field. Anybody on intravenous nutrition in a hospital, either in ICU or on a hospital ward with a central line or a PICC line, or a Hickman’s line can go home with our service Intensive Care at Home, because we are a team of critical care nurses. And in order to manage TPN at home, you need a critical care nurse full stop. A central line needs to be managed. There’s a lot of room for error when you manage TPN and central line, PICC line or a Hickman’s line, but it can be safely done at home. There is no issue around that as long as you have the right team.
Coming more to the differences of Intensive Care at Home versus intensive care, at the end of the day, it’s:
- Intensive Care at Home is a genuine alternative to a long-term stay in intensive care.
- It provides quality of life/quality of end-of-life at home for mainly long-term ventilated patients with a tracheostomy.
- We’re basically setting up a mini ICU at home with all the equipment, with all the monitoring but more importantly, with all the staff that you or your loved one needs and we’re bringing the intensive care and the intensive care expertise into someone’s home.
And we are now employing hundreds of years of intensive care experience and combine that with our now eight years of experience in the Intensive Care at Home field. It’s a powerful skill that we build. We build powerful intellectual property to provide this service at home for families and patients in intensive care.
And in this day and age, there’s no reason why you can’t set up at home what you can set up in intensive care. Now, are there some things that are missing? Of course, there are some things that are missing, but again, in this day and age with technology, in particular, an intensive care specialist is only a phone call away. An x-ray review is only an app click away. There are now services and here in Melbourne, specifically, that provide home x-ray services. So there is really nothing at home that can’t be done anymore that up until a few years ago was only done in intensive care.
What is also changing now is clearly more and more funding bodies, whether it’s hospitals, whether it’s here in Australia, the NDIS, whether it’s in America, Medicare, Medicaid, they’re also realizing that previous concepts have massive flaws. They have massive flaws. You can’t just keep a patient in intensive care forever and a day. You can’t just withdraw treatment for a patient in intensive care and let them die because there are no, what I refer to, no perceived alternatives.
Well, Intensive Care at Home is that alternative. It’s not a perception. It’s reality. We’ve been doing this now. We’ve been providing hundreds of thousands of hours of Intensive Care at Home nursing services in the community. And it just keeps growing bigger and bigger and the need is just getting more and more. And hospitals and health insurances are realizing, this is a real win-win situation. The intensive care bed is the most expensive bed in a hospital and we can cut that cost by 50%. And we can free up a bed in ICU that provides room for another critically ill patient in the hospital.
And of course, we’re providing you, the families, with that much-needed alternative, where you can finally leave the confinements of an ICU. You don’t have to stay there day and night, even worse at the moment with COVID. You don’t even get there in the first place. You are locked out of many ICUs at the moment. It doesn’t matter where you are in the world. Many ICU’s are still in lockdown because of COVID. So you are not even in a position to see your loved one, or you can only see them on a camera, on Zoom or Skype, or even on WhatsApp. So, it’s a massive challenge for families to even have access to their loved one, let alone negotiate with the doctors, with the nurses, getting insights with the doctors and the nurses asking all the right questions from the doctors and the nurses.
And it’s a massive challenge for families and one way out of this dilemma really is to look at the option of Intensive Care at Home. So let’s just quickly look at the discharge at how can you make that happen? So, once you’ve identified, or we have identified together with a family, with a client, with the intensive care team that Intensive Care at Home, is the right thing to do, we need to obviously establish that the home is safe, that all the equipment is organized and we can help you with that. We’ve done it so many times, we know what is needed in a home care environment. Then we can get that organized. We can then start looking at organizing a staff roster. Obviously, that is after funding for the services in place. And again, funding is not as difficult as you think it is because which health fund would not be interested in cutting the cost of an intensive care bed by 50%. I mean, it’s a win-win situation. It’s a no-brainer. So, everybody is winning in that equation.
So, other questions you might be having are the selection of staff. So when it comes to the selection of staff, we hire critical care nurses with a minimum of two years intensive care experience. Most of them have like a post-graduate critical care qualifications, a certificate, a diploma, or even a master’s. So we are coming with a highly skilled workforce that can make that transition from intensive care to Intensive Care at Home possible.
Now, especially for our friends in the United States, one way to consider or there is one step in the process when you need to consider Intensive Care at Home and that is when the intensive care team is suggesting to you to have your loved one go to LTAC or to subacute facilities. That’s when you actually need to come in with Intensive Care at Home.
But even prior to that, I mean, we recommend for any family in intensive care that you do research from day one when you have a loved one in intensive care. Most families leave it too late and they never do their research. And we have another side of our service. We’ve got Intensive Care at Home, and we also have Intensive Care Hotline where we help families of critically ill patients in intensive care with a consulting and advocacy service, which is one of our ways to help educate intensive care units about Intensive Care at Home as well, because still many intensive care units have not heard about Intensive Care at Home yet.
So, that is about staff selection. It takes a little bit of time getting a team together of course. It’s not an overnight process and also what is important for you is you want to have the right people on the team. You want to have a good combination of staff that are the right fit for you. Also, for a 24-hour roster at home, we have found, we need anywhere between 10 to 14 staff to keep a roster stable and safe to manage shortfalls like last-minute sick calls, family emergencies, people going on vacation and, so forth. So we do need a fair few people on our roster. And we also understand that, for families, it’s quite important to have stability on a roster and not have a revolving door and not have people coming and going.
And the same is relevant for us. It’s important for us that we have stability. We don’t want to have different people going to a different client every day, because we understand that the routine for a client is very important. You want to get to know people, you want to form relationships with them. You want to build rapport with them. And it’s the same for us. We want to build rapport with you and our staff wants to build rapport with you. That’s critically important of course, that we can do that.
And staying with the topic of staff selection, you might be saying, “Oh, I don’t want 10 or 14 people coming into my home.” Well, the reality is that, again, we want to minimize it as much as possible but you’ve got to keep in mind that a lot of our staff members are part-time. They have young families, they have kids to look after. So as much as we all want them to do three, four shifts a week at sometimes just not feasible because of their lives outside of their work commitments. But what we will guarantee you is, we will guarantee you that we have staff that are qualified to look after someone with a tracheostomy and on a ventilator. And that means what we then need to focus on as the next step, we need to focus on the routine of your loved one. So the most important thing is that we have someone that’s qualified to look after the ventilator and a tracheostomy. And then we can focus on learning about the routine of a client, learning about the fine details, what to do, when to do them, and so forth.
Having the critical care nurse at home is also what makes the discharge process possible. You look at intensive care units, patients on ventilation and tracheostomy can’t really leave intensive care without an intensive care nurse, which is again where Intensive Care at Home is coming in. And that’s why we employed such a highly-skilled workforce. There are some organizations out there that might offer you a support worker or might offer you a general nurse without intensive care experience. Well, let me shine some light on that very briefly. The reality is that if you do that, patients are dying. We’ve been in this environment long enough to know that anything less than an intensive care nurse at home puts a patient at risk of dying.
And we’ve seen many clients die in the community, unfortunately, whenever we weren’t involved quite frankly. And I know that you might be thinking I’m making it up. I’m not making it up. I can give you evidence for a client’s deaths in the community whenever there are no critical care nurses present like we have at Intensive Care at Home. It’s very sad and it can be avoided by looking at the right service in the community to begin with.
So, then quickly going back to equipment. So you need a ventilator, you need a suction machine, you need a monitor, you need a special care bed. You might need a wheelchair. You might need a recliner chair. You need a nebulizer, most likely you need spare tracheostomies, you need a tracheal dilator, you need an ambu bag or resuscitation bag. Also known as Air viva bag in some circles. You need face masks. You need Guedel airways. You might need some nasopharyngeal airways. You might need a humidifier. But we can help you with all of that. We have the expertise making all of that happen. You would need spare tracheostomies for an emergency. You need suction catheters and you need obviously, always two of anything because you always need a backup at home.
Now, let’s just quickly look at the medical set up and let’s just quickly look at how do we work with doctors, how do we work with hospitals. It really depends on the doctors and the hospitals in what they would want and what you want as a family as well. We work with intensivists. We work with respiratory physicians. We work with anesthetists. Sometimes we work with pediatricians and we also work sometimes with GPs. So there’s really no limitation, I guess, given that we are a highly skilled workforce, we can work with anyone and it’s a two-way street. We can guide them. They can guide us. There is no issue around that.
I should also quickly talk about our KPIs or also known as “Key Performance Indicators” because you as a family benefit from our KPIs. For us, it’s all about creating win-win situations for everyone. We have two KPIs. We try to keep business simple. We have identified two KPIs, number one, zero non-elective readmissions back to ICU. That’s one of our KPIs and the other KPI is to have 100% of all shifts filled with our clients and with our staff. It’s very simple. If we achieve those KPIs, everybody’s winning and everybody gets what they want. And we’re striving for that every day. We have a very committed admin team. We have a very committed team of critical care nurses on the road, going places, making things happen, and doing what is right for the client. Doing what is right for hospitals. Doing what is right for the funding bodies, and doing what is right for us as a service provider. We have nurses and admin people on call 24 hours a day. I have done a lot of the hands-on work myself.
So, it’s very enjoyable. It’s very rewarding, going out to clients and keeping them home. It’s fantastic. Seeing how their quality of life improves and that their life is so much more enjoyable at home compared to a depressing sterile often void of natural daylight intensive care unit. And the rigidity of an intensive care unit where people can’t even have visitors nowadays, they can’t determine their own routine. In this day and age, there are still some intensive care units that wake people up at 4:00 AM in the morning to give them a bed bath. Bed baths need to happen in ICU, but not necessarily at 4:00 AM. But that also leads me to talk about bed baths in ICU. At home, we endeavor to get people to a shower and not necessarily give them a bed bath, unless, there might be some days where people prefer a bed bath, of course, but our goal is always to get people to have a shower.
Now, from my days in ICU, I do remember, looking after patients after cardiac surgery and maybe not quite the first day, but the second day in ICU, before they’re going to the ward, you get them to a bathroom, you get them to a shower and it’s better than any medication under the sun. Those people feel like they’re reborn. Some of the comments that I had from patients over the years were like, “Oh my goodness, this is so good. This is the best thing that happened to me in the last two days. Now I’m feeling like a human again.” And it’s the same for our clients, if you get them to the shower and treat them as an actual human being and make them feel like they are human beings, it makes all the difference in the world. Little things matter big time.
But I’m also curious what questions do you have about Intensive Care at Home? Is there something that’s a burning question for you that I haven’t touched on? Maybe you want to ask more about the funding side of things. Maybe you want to ask more about the staff selection. Maybe you want to ask more about the equipment. Maybe your location is a concern, and I should probably touch on location as well. We are providing services in metropolitan areas predominantly, but we also have experienced providing services in rural/remote areas quite successfully. We have even gone as far as providing fly-in, fly-out services for some of our clients quite successfully. It all comes down to staff selection. It comes down to planning. So, again, there are no limitations from our end in terms of what we can and what we can’t do.
As a matter of fact, we pride us on a “can-do attitude.” And this is also what I believe makes us very different from an intensive care unit. In hospitals, it’s all about a “cannot do attitude”. It’s all about what are the rules and regulations. And don’t get me wrong. We have rules and regulations too, but our rules and regulations are structured around a client’s need and not around the hospital’s politics need. This is what’s been so frustrating in a hospital working there, but I also know it’s a frustrating point for families in intensive care, working with the bureaucracies and the red tape in the hospital. And we’re trying to remove that red tape as much as we can.
We also believe that by now we have the workforce that is really tuned in with our client’s needs because it is the dynamics in Intensive Care at Home are the opposite of an intensive care unit. Clients want to be in control and they can be in control. It can be a little bit daunting for some intensive care nurses letting go of that control, especially if they’ve worked in ICUs for so long. But we have done that, again, successfully. Educating our staff as well about the client’s needs. It’s a very sensitive environment, as you can probably imagine. And I would hope that we as a service are tuned in with the sensitivities of the home care environment.
Now, if you have a loved one in intensive care and you are thinking about Intensive Care at Home. Now, I urge you to reach out to us as quickly as possible, but I also urge you to plant the seed with the intensive care team and tell them that is what you want. You want Intensive Care at Home. And don’t be surprised if they think you’re crazy or don’t be surprised if they dismiss it. Don’t be surprised if they’re saying they’ve never heard of it. Don’t be surprised if they are reluctant to embrace the new and whilst I don’t think it’s new, in their mind, it probably is new.
So, it’s just a matter of re-educating them, giving them the reassurance that this is something that has been done successfully for decades now. And it’s continuing, whether they like it or they don’t. And if you help them to look at the bright side as well, which is again, emptying one of the ICU beds and cutting the cost of an ICU bed. Again, you’re a part of creating that win-win situation that everybody can benefit from.
Now, I’ll spend a little bit more time on the equipment side of things. For example, home ventilators are much smaller than the ventilators you see in intensive care. However, I can assure you that a lot of these, most of those ventilators have all the same functionalities than a ventilator in intensive care. They are specifically geared for home care. And just because the ventilators are smaller compared to the ventilators you see in ICU does not stop you from going home. So the equipment side of things is not an obstacle. Nothing really is an obstacle to go home. Besides the mindset of people in intensive care, nothing would stop you from going home. If you engage with us, we’ll make it happen for you and with you. And don’t let the intensive care team stand in the way.
In this day and age, especially with technology. Everything is possible. In this day and age, especially with a COVID pandemic, you do not want to be stuck in intensive care by any means. Another suggestion is, if you are wanting to try this out, the other thing we can do is we can just take your loved one home maybe for a weekend and see how you feel and give it a bit of a trial run, and that will help you as well to make this transition possible.
So I close this down now for today, I hope that has given you some insights. For more information, please go to intensivecareathome.com. Also, check out intensivecarehotline.com where our consulting and advocacy service is for families in intensive care and I will talk to you again next week.
Thank you so much for your time.
Take care for now and I wish you and your families all the very best.
Now, if you have a loved one in intensive care and you want to go home with our service intensive care at home and if you want to find out how to get funding for our service and how it all works, please contact us on one of the numbers on the top of our website, or send me an email to [email protected] That’s Patrik, just with a K at the end.
Please also have a look at our case studies because there we highlight more about what we can do for clients, how clients can live at home with ventilation and tracheostomies and you can look at our case studies as well at our service section
And if you are at home already and you need support for your critically ill loved one at home, and you have insufficient support or insufficient funding, please contact us as well. We can help you with all of that.
And if you are an intensive care nurse or a pediatric intensive care nurse with a minimum of two years, ICU or pediatric ICU experience, and you ideally have a critical care certificate, please contact us as well. Check out our career section on our website. We are currently hiring ICU and pediatric ICU nurses for clients in the Melbourne metropolitan area, Northern suburbs, Mornington Peninsula, Frankston area, South Gippsland, as well as Wollongong in New South Wales.
So we are also an NDIS, TAC (Victoria) and DVA (Department of Veteran affairs) approved community service provider in Australia. Also have a look at our range of full service provisions.
Also, we have been part of the Royal Melbourne health accelerator program in the past for innovative healthcare companies.
Thank you for watching this video and thank you for tuning into this week’s blog.
This is Patrik from intensive care at home, and I’ll see you again next week in another update.