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Today, I want to focus on what a day for our clients might look like when they’re very complex on BIPAP (Bi-level Positive Airway Pressure) with cerebral palsy.  “What does the day look like and can they still have community access?” Because that’s a question we get quite frequently from our clients or potential clients, and I want to do a deep dive there today.

My name is Patrik Hutzel from intensivecareathome.com.

Today, I just basically want to read out one of the nursing reports from one of our nurses who was working with a complex client with cerebral palsy on BIPAP. I’m obviously not going to mention names, but it gives you an idea because especially with NDIS (National Disability Insurance Scheme), there’s a lot of very complex cerebral palsy clients out there that need help.

So, that’s the beginning of the shift. This is a day shift, obviously.

“Client asleep with BiPAP machine on. 8:30 and 9:00 medications and feeds given. BIPAP off at 9:30, SPO2 (oxygen saturation) 97% on room air. Oral care attended. Client mobilised from bed to chair by the mother who carried the client into mobility power chair. The client lifted in chair by the nurse while the mother attended to hip alignment in the chair. Stimulation given via feeding tube at 10:00am. Went to neighboring home care center with one of our other RNs and returned home at 1:00pm. Client is engaging and is alert, mostly stimulated on shift. Two neuro drops today – lasted <10 seconds each before the client recovered on her own. Client is supporting her own airway at present, it’s patent with oxygen saturation on 97% on room air, with audible secretions to be suctioned out, no increased work of breathing, thick pale yellow secretions removed. Hypertonic normal saline nebulizer given. Remains warm and well-perfused. Bowels not open, feeds given as charted. PEJ skin looks healthy. PEJ means jejunostomy tube. Nil leakage observed in morning, dry and intact hourly 125mL water flushes given. Large wet pad, urine is NAD. Small pressure injury noted to sacrum – not blanching as it remains pink while surrounding skin is blanching.

NPA and OPA suctioning required every 30 to 60 minutes for thick, clear, creamy secretions. So, NPA is a nasopharyngeal airway, and OPA is an oropharyngeal airway. Basically, it’s like a plastic tube that goes either into the mouth or into the nose that guides the suction catheter to do some deep suctioning in the lungs. Now, that can be very uncomfortable, but it is also extremely effective most of the time, quite a few of our clients require deep suctioning, and it is a skill that requires a critical care nurse, not just even a general registered nurse.

Hypertonic saline and aztreonam nebs were given. Heart rate and oxygen saturation remained within normal range during the afternoon nap on BIPAP. Flickering was noted with 11 witnessed atonic drop seizures. PEG tube is leaking mildly. Dressing was changed and sudocream was applied to the over-granulating skin, which remains unchanged. Client is tolerating feeds. Bowels open: medium x 2 type 6. Large voids x 3 with minimal vaginal discharge. The abdomen is soft, but slightly distended bowel sounds are present. Stage 1 pressure injury to sacrum remains unchanged despite decreased chair time and massage. 1 cm above the sacrum, there is new skin redness, but it’s blanching and is improving. The right axillary skin breakdown remains stagnant. Personal care attended. Feeds and flushes were given as charted. Client went for a walk around IKEA with staff and her family. Client had increased tummy smacking and appeared cranky, which settled. Client had a good rest in the afternoon. Heart rate from 90 beats per minute down to 60. Potassium, 2.5mmol, (KCL 30 mmol administered in Calcium 2.81mmol were administered.)”

So you can see that with the report, there’s a lot of work that goes into the day to day care for our clients, of course, especially when they’re complex, when they have compromised airways, which is the case with this particular client. But, we can still take care of the client, and then they can still have community access, as described in the report. They can still have all their care needs met, irregardless of whether they have community access or not. We can give the same care to your family member if your family member needs help in similar situations.

So, with Intensive Care at Home, we are currently sending our ICU and critical care nurses into the home, 24 hours a day. That means, we are providing a genuine alternative to long-term stay in intensive care for ventilation, tracheostomy, Home BIPAP (Bilevel Positive Airway Pressure), Home CPAP (Continuous Positive Airway Pressure), ventilation without tracheostomy, tracheostomy without ventilation, Home TPN (Total Parenteral Nutrition), home IV potassium and home IV magnesium infusions, IV fluids, and IV antibiotics. We’re also providing cough assist management at home. We’re also providing ventilation weaning at home. We’re also providing central line management, PICC (Peripherally Inserted Central Catheter) line management, Hickman’s line management, as well as port management at home. We’re also providing nasogastric tube and PEG (Percutaneous Endoscopic Gastrostomy) tube management at home as well as palliative care services at home. We also use cough assist machines for our clients for airway clearance.

That also means we’re in a position to cut the cost of an intensive care bed by around 50%. An intensive care bed costs between $5,000 to $6,000 per bed day. Our services cost between $2,500 to $3,000 per day and we’re freeing up the most sought-after bed in the hospital, which is the ICU bed. But most importantly, we’re improving the quality of life for patients and their families, which is a win-win situation for all stakeholders. Of course, quality of life at home is much improved surrounded by families.

With Intensive Care at Home, we are currently operating all around Australia in all major capital cities as well as in all regional and rural areas. We’re an NDIS (National Disability Insurance Scheme) approved service provider all around Australia, TAC (Transport Accident Commission) and WorkSafe in Victoria, iCare in New South Wales, NIISQ (National Injury Insurance Scheme in Queensland), as well as the Department of Veteran Affairs (DVA) all around Australia. Our clients and we, as a provider, have also received funding through public hospitals, private health funds, as well as departments of health.

We are currently 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 level of accreditation since 2012. No other service provider has achieved this high level of accreditation in the community and has created more intellectual property for 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, which 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 if you’re stuck in an ICU, or if you’re going to hospital and ED (emergency department) all the time, and you realize that you don’t have the right level of support, I’ll give you another tangible and real-world example today, very similar to the one I gave you a minute ago.

One of our first clients when we first got started over 10 years ago, was a client who was at home initially on a ventilator with a tracheostomy with a support worker model 24/7. Of course, support workers are dangerous and negligent. Having support workers looking after a client at home on a ventilator with a tracheostomy is like flying the airplane with the cabin crew instead of the pilot because anyone on a ventilator with a tracheostomy is at very high risk of medical emergencies 24/7 or even at high risk of dying if they don’t have a team of critical care nurses looking after them 24/7. This is actually evidence-based and it’s documented in our Mechanical Home Ventilation Guidelines that you can find on our website at intensivecareathome.com.

Think about it, in an intensive care unit in a hospital, you wouldn’t have support workers looking after a critical care patient on a ventilator with a tracheostomy. So, why would anyone in their right mind would do that in a home care environment in the community?

So, this client found out about us eventually and the ICU that he went back to all the time also knew about us and eventually reached out to us. We were proving our concept with this client very fast. When we worked with the client, we sent him intensive care nurses, 24 hours a day. He never, ever went back into ICU ever again and we were proving our concept there very fast.

We can do the same for you if you’re not safe at home which includes the advocacy for funding that goes along with it. We have always successfully advocated for our clients. Otherwise, we would not be in business. The same is applicable for those stuck in an ICU, similar to our case study today, or going back to ED all the time, so what you’re looking for? Reach out to us, we’ll make it happen for you as well. We can take you through the right steps including NDIS or other funding bodies, and the advocacy that needs to go along with it.

Which is also why we are providing Level 2 and Level 3 NDIS Support Coordination. We have a team of NDIS Support Coordinators, and they have a wealth of knowledge. I’ve done an interview with Amanda Riches, one of our NDIS Support Coordinators, and I’ll put a link to an interview with Amanda in the written version of this blog. 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 from another organization 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 what evidence to provide, I encourage you to reach out to us as well. 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, high-performing team of critical care nurses in the community, we are employing hundreds of years of critical care nursing experience combined. If you are 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, and in Warragul in Victoria. If you have worked in critical care nursing for a minimum of 2 years pediatric ICU, ED, and you have already completed a postgraduate critical care nursing qualification, we will be delighted hearing from you.

I have a disclaimer, because we are offering a tailor-made solution for our clients, which includes regular staff, our clients also do want the same staff coming over and over again because they are very vulnerable and very special, and that’s why we need regular staff. So, if you’re looking for agency work where you can come and go, this will not be the right fit for you. We are 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 if you’re really keen on building relationships with us and with our clients.

If you are 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 you 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 much more cost-effective than what you’re paying for in ICU and ED, and you get the same level of care.

If you’re a hospital executive watching this and you have bed blocks in your ICU, ED, and respiratory wards, home TPN, please reach out to us as well. We can help you eliminate your bed blocks very fast.

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 website or simply send us an email to [email protected].

If you like my videos, 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, share the video with your friends and families, and comment below what you think about this video or what you want to see next.

Thank you so much for watching.

This is Patrik Hutzel from intensivecareathome.com and I will talk to you in a few days.

Take care.