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“Why your loved one with a C2 spinal injury and a ventilator and a tracheostomy needs a 24-hour ICU nurse, not a support worker.”

My name is 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 Home TPN (Total Parenteral Nutrition), IV antibiotics, PICC (Peripherally Inserted Central Catheter) line, central line, Hickman’s line, and port management at home, as well as BIPAP (Bilevel Positive Airway Pressure), CPAP (Continuous Positive Airway Pressure) ventilation without tracheostomy, tracheostomy care without ventilation, cough assist management, nasogastric tube, and PEG (Percutaneous Endoscopic Gastrostomy) management at home.

Are you caring for a loved one at home who’s ventilator dependent with the tracheostomy, who has a C2 spinal injury? If so, you might be wondering about the level of care they need, or you might be a hospital thinking about discharging a C2 ventilated tracheostomy client.

Some families consider using support workers, some NDIS support coordinators are considering using support workers, but let me tell you here right now that that would be a death sentence. Unfortunately, I have no other way to sugarcoat it, because I’m here to tell you why that would be a big mistake and why 24/7 ICU nurses are non-negotiable for safety, peace of mind, and it’s also evidence-based.

Let’s look at a real-life example. There’s a C2 quadriplegic client in the community who’s ventilator dependent with a tracheostomy. The case highlights the complex high acuity care that only an ICU nurse can provide at home.

So, let’s look at number 1, managing a ventilator and tracheostomy is not for amateurs. The client is dependent on an Astral ResMed ventilator, and the client has a tracheostomy tube that was recently upsized to a size 9. The care plan involves specific ventilation programs, different programs for different times of the day, including one for when the client is sleeping and another for when the client is awake. On top of that, the client is doing some diaphragm pacing sessions, which requires the ventilator to be used for 20 to 30 minutes at a time, 5 times a day, with at least 1 hour of rest in between.

A support worker simply does not have the training or understanding to manage these intricate details. Mechanical ventilators that are attached to a tracheostomy can malfunction, and tracheostomies can become dislodged or blocked, leading to a life-threatening medical emergency. An ICU nurse is trained to troubleshoot these issues and act fast and in a timely manner.

Also, it’s evidence-based to use 24/7 ICU nurses at home for a ventilated and tracheostomy client with a C2 spinal injury. When you look on our website at intensivecareathome.com, there is a section, the Mechanical Home Ventilation Guidelines. They are evidence-based guidelines that clearly recommend and suggest and demand that only critical care nurses with a minimum of 2 years critical care nursing experience can safely look after a ventilated and tracheostomy client in the community. This comes out of over 25 years Intensive Care at Home nursing from Germany and over 13 years of Intensive Care at Home nursing in Australia.

Next, handling complex medical issues. This isn’t just about the ventilator. The client’s medical history is a textbook example of why a high level of clinical oversight is essential. The client has a history of chronic pressure sores, which is probably a result of not having critical care nurses, making sure the client doesn’t develop any pressure sores in the first place. The client has also been on long-term antibiotics, and the pressure sores require regular dressing changes.

The client also has heart and vascular conditions. Client had chest pain, CT scans showed extensive triple-vessel calcified plaques, high calcium score, and suspected severe stenosis. An angiogram showed non-obstructive coronary heart disease, but the client was also prescribed new medication, including aspirin to manage the condition and risk factors.

There’s a history of chronic chest infections with a recent course of antibiotics for Pseudomonas infections. This is a serious infection that requires careful monitoring. There are also documented allergies to opiates and some tape. This is critical information that only a qualified nurse would be aware of to prevent a severe reaction.

Medication management, the client is on a long list of medications, including several new ones, like anticoagulation included. The client takes baclofen for muscle spasms with the dose recently increased. The medication list includes regular medications like, again, strong blood thinners and others for pain, depression, cholesterol. The list also includes as needed medications like opiate patches for pain.

Support workers are not legally or clinically qualified to manage such complex medication regimens, especially with medications like blood thinners or opiates, where a mistake could be absolutely fatal.

Next, proactive and holistic care needs to be provided. Beyond the immediate tasks, critical care nurses, 24 hours a day, provide proactive and holistic care, not just reactive care. They’re trained to notice subtle changes in a patient’s condition that could signal a looming crisis. They can assess vital signs, understand the indications of a fever, or recognize early signs of a respiratory issue. They know how to manage issues like edemas, like brewing chest infections, brewing UTIs, and so forth.

In this case, the client also has a PEG tube, he has a SPC (suprapubic catheter), which was recently changed due to draining blood stained urine. The question is, why was there blood stained urine in the first place? Why was it not detected early and troubleshooted?

A new silicone 20 French SPC was inserted and is now draining well. Again, this is the task of a registered and critical care nurse, not of a support worker. The nurse’s notes also mention a PEG tube with some mold growing around the site, pending review by the home care team. These are all things that a support worker would not be trained to identify or manage, which is probably why mold grew in the first place.

The bottom line is this, when a person’s life depends on a mechanical ventilator and tracheostomy and they have multiple complex medical conditions, the person caring for them needs to be qualified ICU nurses, 24 hours a day.

Here at Intensive Care at Home, that’s exactly what we provide, 24/7 critical care nurses from experienced ICU nurses, giving you the assurance that your loved one is in the safest of possible hands.

Also, from a hospital perspective, that the clients do not go back to hospital so that they can live a good quality of life at home, predictably, instead of in ICU.

If you have a loved one with a tracheostomy and a ventilator, contact us today or if you’re a hospital and you want to discharge ventilator tracheostomy patients into the community safely, contact us today and learn more about how we can help you bring them home safely.

Now, with Intensive Care at Home, we are currently sending our ICU and critical care nurses into the home, 24 hours a day. We are providing the following:

• Home care services for ventilated adults & children with tracheostomies  with critical care nurses 24 hours a day
• Genuine alternative to a long-term stay in intensive care or at long-term acute care
• Tracheostomy care for clients without ventilation
• Home care services for patients on non-invasive ventilation such as Home BIPAP (Bilevel Positive Airway Pressure), Home CPAP (Continuous Positive Airway Pressure)
• Home TPN (Total Parenteral Nutrition), which is also known as IV nutrition
• Home IV potassium and home IV magnesium infusions, IV fluids, and IV antibiotics
• Providing central line management, PICC (Peripherally Inserted Central Catheter) line management, Hickman’s line management, as well as port management at home.
• Providing nasogastric tube  and PEG (Percutaneous Endoscopic Gastrostomy) tube management at home
• Use cough assist machines for our clients for airway clearance at home
• Palliative care services at home
• Ventilator weaning 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 Area Health District, their in-touch program, saving approximately $2,000 per patient that we keep at home, instead of them going to an emergency department.

That also means, we’re also 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 costs between $2,500 to $3,000 per bed day, 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. Of course, quality of life is much improved surrounded by families and by a team of dedicated intensive care nurses in the home care setting instead of in an intensive care unit.

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 work with NDIS (National Disability Insurance Scheme) clients all around Australia, TAC (Transport Accident Commission) and WorkSafe in Victoria, Department of Veteran Affairs (DVA) all around Australia. 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 having policies and procedures for Intensive Care at Home nursing and we’ve built all the intellectual property for Intensive Care at Home since 2012. No other provider in Australia 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, 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 you’re stuck in an ICU long-term, or if you’re going to the hospital and ED all the time, and you realize that you don’t have the right level of support at home, or if you are stuck in an ICU, I’ll give you a real-world example today, how we can help you.

One of our first clients when we first got started in 2012 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 not equipped to look after a client at home on a ventilator with a tracheostomy. That is dangerous and it’s simply negligent. Having support workers looking after a client at home on a ventilator with a tracheostomy is like flying the airplane with a 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 dedicated critical care nurses looking after them 24/7 at home. This is actually evidence-based and is 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 your critically ill loved one or after any critically ill patient on a ventilator with a tracheostomy. So, why would anyone in their right mind do that in the home care environment in the community?

So, this client at the time found out about us eventually, and the ICU that he was basically living in also knew about us and eventually reached out to us. We were proving our concept with this client very fast. When we worked with this particular client, we sent him critical care nurses, 24 hours a day. He never ever went back into ICU ever again, as long as we were working with this client.

We can do the same for you if you’re not safe at home and help you with keeping you at home predictably. Otherwise, we would not be in business. Again, the same is applicable for those stuck in an ICU, similar to this case study that I’ve just given you, or if you’re going back to ED all the time, please reach out to us. We can help you with taking you through the right steps, including how to get funding with different funding bodies.

This is also why we are providing 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 need more evidence for nursing care, we are also writing NDIS nursing assessments with legal nurse critical care consulting nurses.

If you are a critical care nurse and you’re looking for a career change and you want to join a very progressive, dynamic, and high performing team of critical care nurses in the community, we’re employing hundreds of years of critical care nursing experience combined. You can join this high performing team if you are a critical care nurse.

If you are looking for a career change as a critical care nurse, we’re currently hiring for jobs for critical care nurses in Melbourne, Sydney, Brisbane, in Albury, Wodonga, in Bendigo, in Geelong, 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 do have a disclaimer though, 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 so vulnerable and so special. 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 you’re really keen on building solid relationships with us and with our clients.

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 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 so 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, or for 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. and 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 this video with your friends and families, and comment below what you want to see next or what questions and insights you have from this video.

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.