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Hi, it’s Patrik Hutzel from intensivecareathome.com where we provide tailor-made solutions for long-term ventilated adults and 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 adults and children with tracheostomies, also otherwise medically complex adults and children at home, including Home BIPAP (bilevel positive airway pressure), Home CPAP (continuous positive airway pressure), home tracheostomy care when adults and children are not ventilated, also Home TPN (Total Parenteral Nutrition). We also provide IV potassium, IV magnesium infusions at home as well as IV antibiotic infusions at home. We also provide port management, central line management, PICC (Peripherally Inserted Central Catheter) line management, Hickman’s line management, as well as palliative care services at home, and that also includes ventilation weaning at home.
We also have provided an emergency department (ED) bypass service as part of a successful tender for the Western Sydney Local Area Health District, the in-touch service where we send our critical care nurses into the home to keep patients out of the emergency department. So, it’s gone now beyond Intensive Care at Home, it’s also now emergency department at home.
So, in today’s blog, I want to talk about a court case that I found out recently in regards to the NDIS being unlawful of trying to delegate registered nurse work to disability support workers. So, the court case is actually from November 2022. Basically, what the background of the court case is that the NDIS wanted to approve a NDIS plan for some NDIS (National Disability Insurance Scheme) participants where they wanted to let disability support workers do registered nurse work. That is like flying the airplane with a cabin crew instead of the pilot.
Now, obviously, the NDIS tribunal ruled in favor of the participants saying, “No, a disability support worker cannot be delegated registered nurse work to them.” The work that the NDIS was trying to delegate and fund was PEG (Percutaneous Endoscopic gastrostomy) tube management, pressure area care, also medication management, including insulin management. So, reasonably low acuity in the bigger scheme of things and they’ve definitely general registered nurse work. Clearly, the Federal Court said, “Well, the tribunal has made the right decision and ruled in favor of the NDIS participants’ case.” Saying, “Well, the NDIS needs to fund registered nurses and not disability support workers.”
Now, here is more context around what we do with Intensive Care at Home and how that ties in here. With Intensive Care at Home, obviously with us sending intensive care nurses into the home for predominantly long-term ventilated adults and children with tracheostomy, the NDIS and other funding bodies at times are trying to delegate intensive care nursing work to disability support workers. That is a recipe for absolute disaster, and patients have died because of it. And finally, the courts have acknowledged that this decision would never be questioned in a hospital. In a hospital, it’s always registered nurses, very little work can be delegated to disability support workers or support workers in a hospital.
Why would it be any different in the community? Why? Because of there’s no lobby or why would it be any different in the community? The framework is the same. A registered nurse is not allowed by their AHPRA (Australian Health Practitioner Regulation Agency) Code of Conduct and Code of Ethics to delegate work to disability support workers, it’s not within the framework. So, the NDIS is basically asking registered nurses to break the law which is just not an option. They’re basically asking us as registered nurses to break the law and more importantly, put their participants, the very people they should be caring for, at risk.
We know at least of six or seven people in the community that have died on ventilation with tracheostomy because they were looked after by disability support workers instead of intensive care nurses, not even general registered nurses. By trying to get disability support workers who last week might have worked in a supermarket stocking shelves, with all respect; now, all of a sudden, I’m asked to look after someone on a ventilator who would be in intensive care, that is madness, it’s negligence. We can’t turn a blind eye on that. Finally, the courts have come to the rescue and saying, “Well, that is just not an option. It is not safe.”
Registered nurses and medical care happen within a legal framework, not in a framework that some bureaucrats at the NDIS who have never looked into what the nurse is doing, what their competencies are, what their capabilities are, and say, “Oh, we can train a disability support worker instead.” That is negligence, especially since people have died because of it.
I’ll give you an example. We’ve had clients where the NDIS was funding night shifts for patients on tracheostomy ventilation, but there was no funding for intensive care nurses during the daytime. We made a lot of noise at the time saying, “Those participants are at risk when we are leaving a night shift and there’s nobody coming in, no intensive care nurse coming in during the day.” There was family looking after these clients, there were disability support workers looking after these clients, even registered nurses without intensive care nursing experience and four clients, at least, passed away during the day because registered nurses without ICU experience, disability support workers, or families could not manage medical emergencies, and those participants died before an ambulance even arrived. Can you imagine that?
So, the NDIS has been grossly negligent in regards to those participants, and now, finally, the courts put a backstop to it and say, “Enough is enough. The legalities around it are not met and please NDIS, stop being negligent, stop asking nurses to break their own code of conduct.”
Here’s the other issue from a nursing perspective. So, let’s just say we as nurses would be doing that. Our professional indemnity and public liability insurance would not cover us because we would be neglectful.
So, thank God, unlike the NDIS, we are actually providing evidence-based nursing care, and you can look that up on the Mechanical Home Ventilation Guidelines on our website. The Mechanical Home Ventilation Guidelines which are evidence based clearly say that only intensive care nurses with a minimum of two years intensive care nursing experience can safely look after clients at home on a ventilator, tracheostomy or even if clients are not ventilated and have a tracheostomy, it needs to be an intensive care nurse with a minimum of two years intensive care nursing experience, the same for BIPAP, CPAP, Home TPN, all of those areas in the community need to be covered with intensive care nurses with a minimum of two years critical care nursing experience.
It’s not negotiable. It is evidence-based. There’s research that’s been done about it as a result of nearly 30 years of intensive care nursing in Germany and over 10 years of intensive care nursing here in Australia with Intensive Care at Home, the evidence is overwhelming and the courts are finally now ruling in everyone’s favor and the NDIS needs to stop putting out plans that are illegal, that are asking nurses to break the law, and break their own code of conduct, put their registration at risk, and put their insurance at risk.
Also, from a disability support worker perspective, they often don’t know what they don’t know. They don’t even know the gravity of the jobs they are taking on. They don’t even know the level of responsibility they are taking on which they are not equipped to take on.
So finally, the courts have come to the rescue and it’s now in black and white, that what we’ve been saying here for the last 10 years, a higher authority has confirmed. Also, when you look at the court case, like I said, this isn’t even about ventilation, tracheostomy; this is about entry level basic nursing care. So, how can intensive care nursing be delegated to disability support workers if the work can’t even be delegated to a general registered nurse? Think about that.
So finally, it’s all in black and white, and the NDIS needs to stop making decisions that are, quite frankly, illegal. And also, for NDIS Support Coordinators watching this, you also need to get familiar with those laws because then you can start advocating for the right things for your participants.
So, I hope that sheds more light on the NDIS space in Australia when it comes to what the NDIS always says reasonable and necessary. Well, it’s certainly not reasonable to have disability support workers do registered nurse work. So, it is reasonable and necessary to have intensive care nurses do intensive care nursing work including in the community, and registered nurses do registered nursing work in the community when it’s applicable for the right client. So, I hope that sheds more light on it.
Now, with Intensive Care at Home, currently we are operating all around Australia. We are in all major capital cities as well as in regional and rural areas. We are a NDIS approved service provider all around Australia. We are a TAC (Transport Accident Commission) approved service provider and WorkSafe approved service provider in Victoria, iCare in New South Wales, NIISQ (National Injury Insurance Scheme) in Queensland and as well as a DVA (Department of Veteran Affairs) approved service provider all around Australia. We have also received funding through public hospitals, departments of health as well as private health funds. So, reach out to us if you need help.
Our website is intensivecareathome.com. Call us on one of the numbers on the top of our website or send an email to [email protected].
If you are at home already and you have insufficient support, or if you’re in IC U and you have a loved one in ICU, you might be watching this and you’re in ICU yourself long-term with the conditions that I mentioned, contact us. We can help you to get out of there.
Like I mentioned, we are also sending our critical care nurses into the home to keep emergency departments empty.
If you are a hospital executive or an emergency consultant watching this and you have overflow in your ED and you have bed blocks, please contact us. We can help you with that.
If you are a NDIS Support Coordinator watching this and you’re looking for nursing care for your participants for more funding because you don’t know how to advocate for nursing care, please reach out to us as well. We can also help you with the specialist NDIS nursing assessment. We also have our own NDIS Support Coordinator Level 2 and Level 3, please reach out to us so we can set you up with the right NDIS Support Coordinator who also understands how to advocate for nursing care.
If you are a critical care nurse and you’re looking for a career change, we want to hear from you as well. If you have worked for a minimum of two years in critical care ICU, pediatric ICU, or ED and you ideally have completed a postgraduate critical care qualification, we want to hear from you. We currently have jobs in Melbourne, Brisbane, Sydney, Albury, Wodonga in Bendigo, in Country Victoria as well as in Warragul in Country Victoria, we want to hear from you.
We are looking for critical care nurses who want to complement our team, people who are team players and people who are looking for regular work. We are a service provider that has a tailor-made solution for our clients, which includes regular team members. So, we are not an agency. So, if you want to come and go, please do not apply. That is not what we do at Intensive Care at Home. We are not an agency. We are a service provider that has a tailor-made solution for our clients. So, please only apply if you’re serious and if you want to make a difference to our client’s life and if you want regular work and if you are going to be reliable because that’s what we need here at the Intensive Care at Home. That’s also what we stand for here at Intensive Care at Home.
If you are an intensive care specialist or ICU consultant, we are currently expanding our medical team. We want to hear from you as well.
If you are an intensive care specialist and you have bed blocks in ICU, I also encourage you to reach out to us as well. We can help eliminate your bed blocks, but more importantly, we can improve the quality of life and quality of end of life for some of your patients and you won’t even pay for it.
If you are a hospital executive watching this, we also want to hear from you because once again, we can help you eliminate bed blocks in ICU, pediatric ICU, respiratory wards, and ED.
If you’re watching this and you’re in the U.K. or in the U.S., and you need help, please reach out to us. We can help you there privately.
Once again, our website is intensivecareathome.com. You can call us on one of the numbers on the top of our website or send us an email to [email protected].
If you like my videos, subscribe to my YouTube channel for regular updates for Intensive Care at Home but also for families in intensive care. Click the like button, click the notification bell, share the video with your friends and families, and comment below what you want to see next, what questions and insights you have.
I also do a weekly YouTube live that you get notified for if you subscribe to my YouTube channel and I will be answering your questions live on the show.
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 for now.