My name is Patrik Hutzel from intensivecarehotline.com, and this is another quick tip for families in intensive care. Here at intensivecarehotline.com, we instantly improve the lives for families of critically ill patients in intensive care, so that you can make informed decisions, have peace of mind, control, power, and influence, making sure your loved one always gets the best care and treatment, even if you’re not a doctor or a nurse in intensive care.

I’m a critical care nurse, having worked in critical care nursing for 25 years. And I have worked as a nurse manager in intensive care for over five years, and I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com, and I can very confidently say we have saved many lives for our clients in ICU, and you can verify that on our testimonial section and on our podcast section where we’ve done client interviews.

So today I have an email from Peter who says,

“Hi Patrik, 

My dad’s 93 years old and in ICU on a ventilator with a tracheostomy. Can he recover at his age? He has been sleeping for about a week. He’s an old man.” 

From Peter.

Peter, thank you so much for reaching out. I want to acknowledge how frightening and heartbreaking this must feel, watching your father lying in an ICU bed, connected to a ventilator, unresponsive for a week. It’s one of the most frightening and distressing situations any family can face.

The short answer to your question is, it depends, and that is not me avoiding the question. Age alone does not determine outcome in ICU. What matters is the underlying diagnosis, your father’s baseline health before his admission, the trajectory of his condition over the past two to four weeks, and critically the goals of care that you and your family want to pursue.

In today’s video, I’m going to walk you through everything you need to understand about your father’s situation, the treatment options available, what his ICU team should be communicating to you, and how you can advocate effectively for him, whatever direction you choose.

So, why age alone does not determine outcome in ICU? This is the question that so many families ask me, and I understand why. 93 sounds like a very advanced age to be on a ventilator with a tracheostomy, but I have seen patients in their late 80s and even 90s who survive ICU admissions, even after cardiac arrest  and return to reasonably good quality of life, and I’ve also seen younger patients not survive. It is not a one size fits all. Generally speaking, the younger patients in the ICU are, the higher the chances of recovery, but once again, it is not a one-size-fits-all.  What you also need to know is approximately only, about 80 to 90 percent of ICU patients survive, right? So that’s the research and that means the odds are in your dad’s favor.

So what the ICU team will be looking at is not simply the numbers, but the whole picture. What is the underlying cause of his ICU admission? What was your father’s functional status before he became sick? Was he living independently, walking, eating, and engaging with family? Does he have significant pre-existing conditions such as heart failure, chronic lung disease, kidney disease, or dementia? What has his trajectory been on the ventilator over the past two to four weeks? Is he moving in the right direction? Has he plateaued, or is he deteriorating?  Has he ever expressed his wishes about life sustaining treatment, either verbally or in an advance care directive?

None of these questions can be answered without full access to his medical records, his nursing notes, doctor’s notes, physio notes, blood results, medications he’s on, vital sign documentation, diagnostics such as X-ray, CT (Computed Tomography) scans, ultrasounds, etc., ventilation charts, fluid balance charts, and lab results. You can leave no stone unturned here to make the best decision, and most importantly, an informed decision.

As a family member, as his next of kin, you have every right to request a full copy of your dad’s medical records. This is not something the hospital can refuse to provide, and I strongly urge you to do this now, not tomorrow. Here’s why this matters so much. Without the records, you are relying entirely on what the ICU team is telling you in brief updates, in brief family meetings, and those meetings, as valuable as they are, often leave out important details. The medical records will tell you everything, not just what they choose to tell you in a meeting. So it tells you what the actual diagnosis is, the primary reason why your father is in the ICU. What treatments have been tried, and how he has responded. What are his ventilator settings? Is he doing any of the breathing work himself? What do his blood tests, kidney function, liver function, and infection markers look like? What the nursing notes say about his level of consciousness and responsiveness. Whether any weaning trials have been attempted and how he tolerated them.

Because when you meet with ICU teams one-on-one, and you don’t have access to the medical records, they will tell you whatever they choose to tell you, and it’s difficult for you to question them. I can question them because I know all the ins and outs of intensive care, right, but it’s difficult for you to question them. They will only tell you what they want to tell you. They’re not even telling you half of what’s going on, and you will realize that when you compare what they’re telling you with what you find in the medical records, and we can help you by not only asking the right questions with or without medical records, but by us looking at the medical records, we can definitely ask the right questions and help you ask the right questions and it’s so much quicker once we looked at the medical records. Otherwise, we have to work our way around questioning and probing the right questions. We will get there. Don’t worry, but having access to the medical records is so much more powerful. Because armed with the medical records and with the right questions, you are in a powerful position to have a genuinely informed conversation with the ICU team or to bring in an expert like myself to help you understand what you are reading and to ask the right questions on your behalf.

So, what does sleeping for a week actually mean? Peter, this is an important clinical question. There are several different reasons why a patient in the ICU may appear to be sleeping or unresponsive, and they’re not all the same thing.

Number one, he’s on sedatives. If your dad’s on a ventilator, it is very likely that he has been receiving intravenous sedation medications such as Propofol, midazolam/Versed or dexmedetomidine, also known as Precedex, to help him tolerate the breathing tube or the tracheostomy and the ventilator.

When patients are deeply sedated, they can appear to be in a deep sleep. This is intentional and doesn’t necessarily reflect brain injury or irreversible damage. Encephalopathy or delirium, ICU delirium and metabolic encephalopathy are extremely common in critically ill patients, particularly older adults. Sepsis, kidney failure, liver failure, medications, and prolonged ICU admission all contribute to this. Patients can appear unresponsive or deeply confused. This is often reversible when the underlying cause is treated. Which is a neurological injury. If your father had suffered a stroke, cardiac arrest, or significant lack of oxygen to the brain at any point during this admission, there may be neurological injury contributing to his reduced level of consciousness. This is an important distinction because it changes the prognosis significantly.

Also, let’s look at end-stage organ failure. In some cases, prolonged unresponsiveness reflects that multiple organ systems are failing and the body is shutting down. This is a very different situation from sedation or delirium, and it requires a very different conversation with the family about goals of care.

Once again, without having access to the medical records and an expert looking at them like we do here at intensivecarehotline.com, with a thorough review of the clinical notes, it is impossible to know which of these applies to your dad. This is exactly the kind of clarity that consulting with myself and my team will provide you. Once again, the ICU team will only tell you half of what’s going on because they don’t have to tell you everything that’s going on, and they will be very selective on what they’re telling you, and it will be around what fits their agenda, not what fits your agenda or what fits your dad’s agenda. It’ll be about the intensive care team’s agenda.

Let’s look at treatment options for your dad. Depending on what the underlying cause of this admission is and where your father is in his trajectory, here are the main treatment pathways the ICU team will consider or should be considering with you.

Number one, continue active treatment and attempt ventilation weaning. If your father’s condition is treatable and there’s clinical evidence that he may be able to recover, the ICU team may recommend continuing full active treatment and working towards weaning him off the ventilator. This would involve treating the underlying cause, infection, heart failure, respiratory failure, etc. Gradually reducing sedation and opiates, he would have also been on opiates, such as morphine or fentanyl, to assess his level of consciousness, but given that he now has a tracheostomy, all sedatives and opiates should be off. And the reason they should be off is that a breathing tube is very difficult to tolerate, and it often needs sedation and opiates. A tracheostomy is easy to tolerate, so he should be off all sedation, full stop.

He should also be having daily spontaneous breathing trials, periods where the ventilator support is reduced or minimized to see if he can initiate his own breathing, nutritional support, physiotherapy, and rehabilitation to prevent muscle wastage.

Next, let’s look at tracheostomy and long-term ventilation weaning. Your dad already has a tracheostomy, which suggests the ICU team anticipated that he would need ventilation support for a prolonged period. A tracheostomy makes long-term ventilation more comfortable and can allow for a more gradual weaning process. Some patients take weeks or even months to wean from the ventilator, and some do successfully get there.

Let’s now look at goals of care conversation, comfort focused care. If the clinical picture suggests that your father is not going to recover to a quality of life that he or your family would find acceptable, or if he has previously expressed wishes not to have his life prolonged by machines, then a shift to comfort-focused or palliative care may be the most appropriate path. This does not mean abandoning your father, it means focusing care on his comfort and dignity. This is a conversation that needs to happen with full information in front of you, not in a rushed hallway discussion, and once again, it should require a third party to look at medical records.

to verify that what the intensive care team is telling you is actually accurate.

If you feel that such a conversation has not been handled properly, I can help you prepare for it and if needed, join the conversation directly with the ICU team.

Let’s now also look at transition to home ventilation and Intensive Care at Home if need be. This is something that many families and some ICU teams even don’t know is possible, but it is real and it happens more than you might think.

If your father cannot be weaned from the ventilator or the tracheostomy or both, but is otherwise clinically stable, going home on a ventilator with 24-hour intensive care nursing may be a viable and genuinely life-improving option. This is not a last resort.   For many families, it is the best outcome available. It’s also the best outcome available for the ICU. I’ll come to that.

What if Dad cannot be weaned off the ventilator? This is one of the hardest things a family can face, but I want you to know that if your father cannot be successfully weaned off the ventilator, there are options beyond staying in ICU indefinitely. At our sister company, Intensive Care at Home, and you can find more information at intensivecareathome.com, we specialize in caring for ventilator-dependent adults and children at home, with and without tracheostomy. We have been doing this since 2012, and we are third party accredited for Intensive Care at Home nursing.

Currently, we are operating all around Australia in all major capital cities, but also in all regional and rural areas, and we also help families in the United States, Canada, and the UK privately, so you can reach out to us wherever you are in this world and we can guide you and help you privately.

So, we employ hundreds of critical care registered nurses in the community to get our clients out of ICU and live a much better quality of life at home than in an ICU unit because here’s what home ventilation and tracheostomy care can look like in practice and in someone’s home. So, invasive home ventilation with tracheostomy for patients that remain tracheostomy and ventilator dependent, non-invasive home ventilation for BiPAP, CPAP, or for patients who are breathing partially on their own, but need support, high flow oxygen therapy at home, and also tracheostomy care at home without ventilation. All of these conditions and situations need 24-hour intensive care nursing because otherwise people would be stuck in an ICU.  And you get 24-hour intensive care nursing at home with Intensive Care at Home for families who want their loved one to spend quality of life at home and the ability to participate in daily life with family rather than being confined to an ICU room.

You can read more about Intensive Care at Home at intensivecareathome.com.  We have shared our evidence-based mechanical and ventilation guidelines there, and you can also learn more about our accreditation and quality standards on our Intensive Care at Home website as well.

And from a bigger picture, you might be wondering who’s going to pay for it. Well, first off, someone is paying for your dad’s ICU bed, which costs $5,000 to $10,000 per bed day. With Intensive Care at Home, it cuts the cost down to 50 percent. And so any health insurance will have an interest in slashing that cost. The ICU needs the bed, so it’s a win-win situation. And especially if ICU keeps talking about withdrawing treatment, they might not know about Intensive Care at Home. So, do your research, reach out to us and we can help you step by step.

So, have a consulting callwith me will help you right now, Peter. If you’re feeling overwhelmed, confused, or like you are not getting straight answers from the ICU team, a consulting call with me or one of my team members is one of the most valuable things you can do right now.

Here’s what we can do for you. Talk to you, set you up with the right questions. Join a phone call or a Zoom call or a video call with the ICU team. You will see that my questioning would change the dynamics in your favor straight away. Once they know you have someone on your team who understands intensive care inside out, you will see the difference in how you are being treated. We can also review your dad’s medical records for you in plain language, no medical jargon, so you understand exactly what is happening clinically. Help you understand what the realistic outcomes are for someone in your father’s situation. Prepare you for family meetings with the ICU team so you know what questions to ask and how to advocate effectively, and I can also join a call directly with the ICU team on your behalf to question, to clarify, and to advocate and to be a strong advocate in your corner. We help you navigate goals of care conversations, whether that means pushing for more treatment or ensuring your father is transitioned to comfort care or to Intensive Care at Home. We explore those transition options to Intensive Care at Home, to home ventilation, if it’s appropriate.

The bottom line, Peter, is this, your dad is 93 years old and has been in ICU for two to four weeks on a ventilator with a tracheostomy. This is a serious situation, but it is not automatically a hopeless situation. Age is one of the factors among many, and without knowing the underlying diagnosis and the full clinical picture, no one can give you a definite answer about his chances of recovery. What I can tell you is this, you deserve full honest information and you deserve informed communication from the ICU team, no holding back. You have the right to access all of his medical records right now. And just as a side note here, we are in 2026. Getting access to the medical records should be no more complicated than you getting access to a URL to a website or to an app with a username and a password, and everything should be there. If it’s any more complicated than that, I can almost guarantee you that they have things to hide. It should be no more complicated than that. It’s 2026. It should be all online and should be ready for you to be reviewed.

Because you have the right to a second opinion, there are more options than most families realize, including the possibility of Intensive Care at Home on a ventilator with specialized intensive care and critical care nursing at home. So you don’t have to navigate this alone. The way I work is I offer a 15 minute free consultation and then I have paid options. You can book me for $999 for a whole week, or you can book me for $99 an hour, or you can book me for a membership where you have access to me and my team online and we review medical records and that’s for $199 a month.

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.