A tracheostomy is a surgically created opening (stoma) made through the front of the neck into the windpipe (trachea) to help a person breathe. A tracheostomy tube is inserted through this opening to keep the airway clear and deliver air directly to the lungs, bypassing the nose and mouth. This procedure is often necessary following an injury, for long-term dependence on a ventilator, or to manage conditions that make it difficult to clear secretions. Patients who require the tube for breathing need specialized long-term medical support upon discharge from the hospital.
Which Facilities Are Equipped for Tracheostomy Care
Standard nursing homes, which focus on custodial care and assistance with daily activities, are not equipped to manage patients with tracheostomies. This specialized medical need requires a higher level of staff training and availability than most conventional long-term care facilities maintain. Tracheostomy care mandates 24-hour access to medical professionals who can handle routine maintenance and respiratory emergencies.
The care needed for a patient with a tracheostomy is defined as a skilled nursing service. Specialized units within Skilled Nursing Facilities (SNFs) or dedicated respiratory care facilities are designed to provide this high-acuity care. These facilities employ Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) who have specific training in tracheostomy management and are available around the clock.
Many of these facilities also have Respiratory Therapists (RTs) on staff or on call twenty-four hours a day to manage the patient’s breathing and respiratory equipment. Long-Term Acute Care Hospitals (LTACs) are another option, providing hospital-level care for patients with complex medical issues, including those who are ventilator-dependent or require intensive respiratory intervention. Admission depends on the documented availability of this specialized, round-the-clock medical staff and respiratory support.
Patient Stability and Admission Criteria
Even specialized facilities do not guarantee acceptance, as admission depends heavily on the patient’s medical stability and specific care requirements. Before admission, the medical team conducts an assessment to determine the level of care required and the patient’s readiness for a non-acute setting. Patients must be medically stable, meaning they should not require the immediate, intensive medical services provided in a traditional hospital.
A primary factor in the admission decision is the frequency and intensity of required tracheostomy suctioning. If a patient requires deep suctioning multiple times an hour due to copious secretions, the facility may determine the care needs exceed their capacity. The patient’s cognitive status and ability to participate in their own care or communicate distress are also considered during the assessment.
Patients dependent on a mechanical ventilator require a higher level of care than those who breathe independently through the tracheostomy. Some specialized SNFs can accommodate ventilator-dependent patients, but this requires a greater concentration of staff and respiratory equipment. The goal is to ensure the patient’s respiratory needs are safely met without the continuous oversight of an intensive care unit.
Daily Tracheostomy and Respiratory Management
Daily tracheostomy management involves routine, specific procedures performed by trained nurses and respiratory therapists. Routine care includes meticulous cleaning of the tracheostomy stoma (the opening in the neck) to prevent skin breakdown and infection. Dressings around the tube flange are changed regularly, often twice a day or whenever they become soiled.
For tubes with a reusable inner cannula, this component is removed, cleaned with a sterile solution, rinsed thoroughly, and reinserted multiple times daily to prevent dried mucus buildup. Scheduled suctioning is performed to clear secretions from the airway; this sterile procedure must be done gently and swiftly to avoid trauma or oxygen deprivation. Staff are also trained in emergency protocols, such as managing a dislodged or obstructed tracheostomy tube.
Monitoring the skin integrity around the stoma is ongoing, as rubbing from the tube or excessive moisture can quickly lead to irritation or pressure sores. The medical team also manages related respiratory treatments, such as nebulized medication delivery and supplemental oxygen. Continuous oversight minimizes the risk of complications and supports the patient’s respiratory health.
Understanding Payment and Coverage for High-Acuity Care
The financial logistics for high-acuity long-term care are complex, requiring a distinction between short-term rehabilitation and indefinite custodial care. Medicare, the federal health insurance program for seniors, provides coverage for short-term stays in a Skilled Nursing Facility (SNF), typically following a qualifying three-day hospital stay. This coverage is intended for rehabilitation, covering up to 100 days per benefit period for skilled services like tracheostomy care.
However, Medicare does not cover long-term custodial care, which is the non-medical assistance with daily activities required after rehabilitation is complete. Once the patient is medically stable and no longer making measurable progress, Medicare coverage for the SNF stay will cease. The patient or their family then becomes responsible for the full cost of ongoing long-term care.
Medicaid, a joint federal and state program for low-income individuals, is often the primary payer for indefinite long-term custodial care. Private insurance policies and long-term care insurance plans may also cover a portion of the specialized care, depending on the policy’s terms and documented medical necessity. Thorough documentation of the patient’s continuing need for skilled care is necessary to secure and maintain coverage.