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Bringing a baby home with a tracheostomy in Georgia
What actually happens between the day the trach is placed and the day you drive home: the discharge teaching, the equipment, the nursing hours, and why the GAPP referral should start while your baby is still admitted.
Most families reading this are somewhere between Egleston, Scottish Rite, Arthur M. Blank or a Level III NICU and their own front door, and nobody has quite explained what the first week home looks like. This is that explanation.
Start the GAPP referral before discharge, not after
If you take one thing from this page, take this. A referral made while your baby is still admitted lets the physician documentation, the Georgia Medicaid steps and the search for a nurse happen in parallel with everything else the discharge team is doing. A referral made after you are home happens in sequence, and you do the first stretch alone with a new trach.
Ask your discharge planner or hospital case manager to contact us directly. They make these referrals constantly. Our line for hospital staff and physicians is 404-771-2570, which reaches our Director of Nursing. Families can always reach us on 678-459-2590.
Before a referred child leaves the hospital, a HeartPath nurse comes to the unit to meet you and learn your baby’s routine from the team that has been doing it. It may not be the nurse who ends up on your permanent schedule, and we will tell you which it is. The point is that somebody from our side has seen your baby before day one at home.
What discharge teaching actually involves
Trach programs generally want two trained caregivers signed off before a baby goes home, and the teaching runs across days rather than a single session. Expect to be taught, and then to demonstrate back:
- Routine suctioning on a schedule, and emergency suctioning when your baby needs it
- Trach tie and dressing changes, with the stoma checked every time
- A full trach tube change, done by you, not watched
- Accidental decannulation: recognising it and replacing the tube
- Bagging through the trach, and CPR on a child with an artificial airway
- Reading the pulse oximeter, and knowing which numbers mean call and which mean 911
Many units finish with a rooming-in night: you run every bit of the care yourself in a hospital room with a nurse down the hall. It is exhausting and it is the most useful night of the whole admission. If it is offered, take it.
What equipment comes home
Your DME supplier delivers most of this, usually before discharge. Ask the hospital which supplier is assigned and confirm the delivery date yourself, because this is a common place for things to slip.
- A stationary suction machine, plus a portable one for the car and the stroller
- Suction catheters, saline and gloves, in quantities that will surprise you
- A heated humidifier for sleep and HME filters for the day
- Spare trach tubes: your baby’s size and one size smaller, always within reach
- Trach ties, dressings and stoma care supplies
- A pulse oximeter, and a resuscitation bag with a trach adapter
- A go-bag that lives by the door and goes everywhere, including the mailbox
Power matters too. Call your utility and get your address flagged as a medical-needs household, and work out now what you do in an outage, because you will not want to work it out at 2am in a storm.
How many nursing hours a trach baby gets
This is the question every parent asks and the one agencies are most tempted to answer dishonestly. There is no set number. GAPP authorizes in hours per week, and the request is built from your baby’s plan of care: suctioning frequency, whether the trach is new, whether oxygen or a ventilator is in the picture, and what the nights look like.
What is true is that a tracheostomy generates a strong and continuously documentable need, which is why trach-dependent children are among the most consistently authorized in the program, and often at high weekly hours. Most families want the overnight shift first, and that is usually the right ask. But Georgia Medicaid decides, the physician’s documentation is what it decides on, and no agency controls either one.
The second question, which is a different question, is whether an agency can actually staff the hours you are approved for in your ZIP code. Ask that one separately and ask it directly. More on trach nursing at home.
The gap nobody warns you about
Discharge dates move faster than authorizations. It is common for a baby to come home before nursing hours are approved, which means the family covers the first days or weeks. That is frightening and it is exhausting, and it is the reason we push so hard on starting early. Every day of documentation done before discharge is a day you are not doing this alone.
If Medicaid is not in place yet
That has to come first. If your household income is over the regular limit, read how Katie Beckett works before you give up on it: that pathway ignores parents’ income entirely and looks only at your child’s medical needs. If you are not sure where you stand, the Path Finder maps it in about three minutes.
Questions parents ask
How many nursing hours does a baby with a tracheostomy get under GAPP?
There is no set number, and any agency that quotes you one before the physician documentation exists is guessing. GAPP authorizes in hours per week, and the request is built from your child’s plan of care: how often the airway needs suctioning, whether the trach is new, whether there is oxygen or a ventilator alongside it, and what happens overnight. Trach-dependent infants generate a strong, well-documented need, which is why they are among the most consistently authorized children in the program, often at high weekly hours. Georgia Medicaid still makes the decision and sets the number.
What equipment comes home with a new trach?
Typically a suction machine with catheters, a portable suction unit for the car and the stroller, a heated humidifier and HME filters, spare trach tubes in your child’s size and one size smaller, trach ties and dressings, a pulse oximeter, a resuscitation bag with a trach adapter, and a go-bag that lives by the door. Your DME supplier delivers it, usually before discharge. Confirm with the hospital which supplier is assigned and when the delivery lands.
What does trach discharge teaching involve?
Most programs want two trained caregivers signed off before a baby goes home, and the teaching runs over days, not one session: routine and emergency suctioning, trach tie and dressing changes, a full tube change, what an accidental decannulation looks like and how to replace the tube, bagging through the trach, and CPR. Many units ask you to room in overnight and run the care yourself with the nurse nearby before they sign off.
Can we start GAPP before discharge instead of after?
Yes, and it is the single most useful thing in this guide. If a referral starts while your baby is still admitted, the physician documentation, the Medicaid steps and the staffing search run alongside the rest of the discharge planning instead of after it. Ask your discharge planner or case manager to contact us directly. Our line for hospital staff and physicians is 404-771-2570.
What if we come home before nursing hours are approved?
It happens, and it is worth knowing in advance rather than discovering it on day one. Discharge dates move faster than authorizations, so families sometimes cover the first days or weeks themselves. Starting the referral early is what shrinks that window. We cannot promise it closes entirely, because the pace of Medicaid’s review is not ours to set.
Does a tracheostomy automatically qualify our baby for GAPP?
No. GAPP publishes no list of qualifying diagnoses and approval turns on documented daily need, not the diagnosis itself. A tracheostomy usually generates that need continuously, which is why trach-dependent children are frequently approved, but the decision and the hours belong to Georgia Medicaid.
Call before discharge if you can.
Tell us about your baby and a real person will walk you through what comes next. No cost, no obligation.
Check eligibility Call 678-459-2590Keep reading
HeartPath Home Care is an approved provider for the Georgia Pediatric Program. We are not a government agency, and this page is not medical advice. Georgia Medicaid decides who is approved, which services are authorized and how many hours. Talk to your child’s physician about your child’s care.