ICU at home: what it takes to run intensive care outside a hospital

What intensive care means: the levels of care

In the UK, the Intensive Care Society sorts patients by the support they need. Its second edition, from 2021, defines four levels.¹

The society stresses that the levels describe the care a patient requires, not where they receive it.¹ That is the starting point for any question about intensive care at home: the question is never whether a home can be an intensive care unit, but whether the care the patient needs can be delivered there to the same standard.

Germany has written this into law. Out-of-hospital intensive care is a statutory benefit for people who need the constant presence of a suitably qualified nurse, and it can be provided in the patient’s own household.⁹

The team: who has to be there

The Guidelines for the Provision of Intensive Care Services (GPICS), published in a third version in January 2026 by the UK’s Faculty of Intensive Care Medicine and the Intensive Care Society, set the minimum standards for hospital units.²

• At least one registered nurse for every level 3 patient, and one for every two level 2 patients, with professional judgement on each shift where needs are higher²
• A nurse in charge of each shift who has no patients of their own, around the clock²
• At least half of the nurses holding a post-registration qualification in critical care²
• A consultant in intensive care medicine leading daytime care seven days a week, with ward rounds twice a day²
• A responsible consultant available around the clock who, when not on site, can attend within 30 minutes²

These are hospital standards. We are not aware of an equivalent official standard for intensive care in a private home, so the hospital benchmark is the fair one to apply to anyone who offers it.

The equipment, and the backup for the equipment

The best-documented form of intensive care at home is long-term ventilation. About 5 percent of ventilated intensive care patients do not wean from the ventilator within 21 days, and some of them go home still ventilated.² In Sweden, 33 in every 100,000 people used home mechanical ventilation in 2020 to 2022, and only 2 percent of new patients were ventilated invasively.⁸

Guidelines for ventilated children at home list what has to be in the house:⁴

• A ventilator and a back-up ventilator, with batteries⁴
• A self-inflating bag and mask⁴
• Portable suction and a heated humidifier⁴
• Emergency oxygen, a nebuliser and a pulse oximeter⁴

For adults the same logic applies. German guidance requires two approved ventilators when ventilation is life-sustaining for more than 16 hours a day,³ and the NHS England specification for complex home ventilation requires 24-hour emergency access to advice and cover for equipment failure.¹⁰ In Great Britain, households that rely on medical equipment with a power supply can join their energy supplier’s Priority Services Register, which gives priority support in an emergency and, where possible, notice of planned power cuts.¹¹

Who can be treated at home, and who cannot

Every official model of hospital-level care at home shares one condition: the patient must not need what only a hospital can provide.

• NHS England’s Hospital at Home for people living with frailty excludes patients who need diagnostics or interventions that are only available in hospital.¹²
• In Dubai, home healthcare patients must be medically stable and able to receive care at home without immediate hospitalisation.⁵
• The US Acute Hospital Care at Home programme admits patients only from an emergency department or an inpatient bed, with at least two in-person visits a day.¹³
• For a ventilated child, discharge home requires medical stability, unchanged ventilator and oxygen settings for at least several days, and the home equipment tried in hospital for 24 to 48 hours.⁴

That separates two situations that are easy to confuse. A patient on stable long-term ventilation, which the Intensive Care Society classes as level 2 care, can live at home with the right team and equipment.¹¹⁰ A patient in an acute crisis who needs advanced support for several organs needs a hospital intensive care unit, which every official model of care at home excludes.¹²⁵ Intensive care at home sits between the two: it holds a stable patient at intensive-care standard, and it gets a patient whose condition changes to the right unit without delay.

The plan for the moment things change

What makes care at home safe is less the equipment than the route back. Official guidance names the same elements again and again.

1. 01

   A named clinical lead

   NHS England expects Hospital at Home to be led by a named consultant or a suitably trained GP, with specialist advice available in and out of hours.¹²

2. 02

   Advice around the clock

   Families caring for a ventilated patient should have a 24-hour helpline for clinical and equipment questions.¹⁴

3. 03

   An agreed way back into hospital

   British guidance asks for a clear re-admission pathway after discharge on ventilation,¹⁴ and in Dubai the home healthcare team should have an agreement with a hospital for emergency transfer.⁵

4. 04

   A plan the patient and family know

   NICE expects patients cared for on a respiratory virtual ward to be supported with a self-escalation plan of their own.¹⁵

Hospital-at-home programmes measure exactly this. In the US, hospitals in the Acute Hospital Care at Home programme report every escalation back to the hospital and every unexpected death.¹³

After intensive care: recovery takes months

Leaving intensive care is not the end of the illness. Post-intensive care syndrome describes new or worsening problems in physical, cognitive or mental health that arise after critical illness and persist after the hospital stay, and the term also covers family members.¹⁶

How common it is depends on how it is measured. Two recent meta-analyses put the share of survivors affected at 54 percent and 60 percent, with very large differences between studies.⁷⁶ In a cohort of 406 survivors of respiratory failure or shock, 64 percent had at least one problem after three months and 56 percent after twelve months.¹⁷

NICE guidance on rehabilitation after critical illness covers the whole stretch from the intensive care stay to two or three months after discharge,¹⁸ and for adults who spent more than four days in critical care and are at risk, it expects a review two to three months after discharge.¹⁹

Questions to ask anyone who offers intensive care at home

1. Who leads the care, and are they available around the clock?²¹²
2. How many nurses per patient, and with what critical care experience?²
3. Which equipment is duplicated, and what happens if the power fails?³¹¹
4. Which hospital takes the patient if their condition changes, and how do they get there?⁵¹⁴
5. Who trains the family, and whom do they call at night?⁴¹⁴
6. Who plans the rehabilitation once the acute phase is over?¹⁸

Shadow ICU’s ICU at home starts from the same questions: clinicians and equipment are placed within reach and held for the full stay, dedicated to a single person, and the receiving hospital is agreed before it is needed.