A tracheostomy—a surgical opening in the neck to provide an airway—requires specialized ongoing care. While many assume nursing homes are the only option, specialized adult family homes can provide excellent tracheostomy care with the benefits of personalized attention in a home-like environment.

Understanding Tracheostomy Care

Tracheostomy care involves multiple daily activities:

  • Suctioning: Removing secretions from the airway
  • Stoma care: Cleaning and inspecting the opening site
  • Tube changes: Periodic replacement of the trach tube
  • Humidity management: Keeping the airway moist
  • Emergency response: Handling dislodgement or obstruction

Types of Tracheostomy Patients

  • Ventilator-dependent (trach connected to ventilator)
  • Trach with supplemental oxygen
  • Trach for airway management only
  • Weaning from ventilator through trach

Common Conditions Requiring Tracheostomy

According to the National Heart, Lung, and Blood Institute, tracheostomies may be needed for various conditions:

  • Neurological conditions: ALS, stroke, spinal cord injury, brain injury
  • Prolonged ventilator dependence: After extended ICU stays
  • Airway obstruction: Tumors, severe sleep apnea, vocal cord paralysis
  • Respiratory failure: COPD, neuromuscular diseases
  • Swallowing difficulties: Severe aspiration risk

Daily Care Routines

Tracheostomy care follows structured daily routines that trained AFH caregivers perform:

Regular Care Tasks

  • Inner cannula care: Cleaning or replacing the inner tube (typically 1-3 times daily)
  • Stoma cleaning: Keeping the site clean and dry, monitoring for infection
  • Tie/holder changes: Securing the trach tube safely, checking skin integrity
  • Humidity: Using humidification devices to prevent mucus from drying
  • Suctioning: As needed based on secretion levels

Monitoring and Documentation

Quality AFHs maintain detailed records of:

  • Suctioning frequency and secretion characteristics
  • Skin condition around the stoma
  • Respiratory status and oxygen levels if applicable
  • Any concerns or changes communicated to healthcare providers

Coordinating with Healthcare Providers

Tracheostomy care requires coordination with multiple providers:

  • Pulmonologist: Overall respiratory management
  • Respiratory therapist: Equipment management, weaning protocols
  • ENT specialist: Trach tube sizing and changes
  • Speech therapist: Swallowing evaluation, speaking valve trials
  • Primary care physician: General health oversight

Good AFHs facilitate appointments and communicate proactively with the care team.

Tracheostomy Care in Adult Family Homes

What Specialized Homes Provide

  • Staff trained specifically in tracheostomy care
  • Appropriate suctioning equipment and supplies
  • Emergency protocols and equipment
  • Coordination with respiratory therapists
  • Experience with trach-related complications

Questions to Ask

  • How many trach patients have you cared for?
  • What training do staff receive for trach care?
  • Who provides respiratory therapy services?
  • What's your protocol for trach emergencies?
  • Do you have backup supplies and equipment?
  • Can staff perform emergency tube changes?

Costs and Coverage

Tracheostomy care is considered high-acuity and costs more than standard care:

  • Typical range: $10,000-$18,000/month in Seattle area
  • Medicaid COPES provides enhanced rates for trach care
  • Supply costs may be covered separately by insurance

Frequently Asked Questions

Can someone with a tracheostomy live in an adult family home safely?

Yes, with properly trained staff and appropriate protocols. Many individuals with tracheostomies thrive in AFH settings because of the personalized attention and consistent caregivers who know their specific needs and warning signs.

How often does a tracheostomy need suctioning?

Frequency varies by individual—some need suctioning several times hourly, others only a few times daily. Staff must be available and competent to suction as needed, any time of day or night.

Can my loved one eat with a tracheostomy?

Many tracheostomy patients can eat normally, though some have swallowing difficulties requiring modified diets or tube feeding. A speech therapist can assess swallowing safety. The AFH should be able to accommodate any dietary requirements.

What happens if the trach tube becomes dislodged?

This is an emergency requiring immediate response. Qualified homes have staff trained to manage this situation, including reinserting tubes when appropriate, using backup airways, and knowing when to call 911. Ask specifically about their emergency protocols.

Can my loved one speak with a tracheostomy?

Many trach patients can speak using speaking valves or by covering the trach opening. Some cannot speak due to their underlying condition. Speech therapists can evaluate options. Communication aids may be helpful regardless.

Finding the Right Tracheostomy Care Setting

When evaluating adult family homes for a loved one with a tracheostomy, families should consider several key factors beyond basic licensure. The right care setting combines medical capability with quality of life considerations.

First, assess the staff-to-resident ratio during all shifts, including nights and weekends. Trach emergencies don't follow business hours. Second, ask about the home's relationship with respiratory therapy services and how they handle equipment maintenance and supplies. Third, inquire about the caregiver's comfort level with the specific type of tracheostomy your loved one has — HME valves, speaking valves, and different tube types require different expertise.

Many families find that adult family homes provide superior tracheostomy care compared to larger facilities because of the personalized attention and consistent caregivers who develop deep familiarity with each resident's unique needs and baseline status.