They live in Cali. My dad has medical issues and is right now is in a long term care facility. He could be there for 3 months. He has a trach and a feeding tube. Not sure he will be able to eat on his own. I felt for their safety they should be in a board and care?
It's just that the way you phrase your headline question isn't the most promising of starts - your sister thinks she can care at home for two people with dementia, one of whom will require specialist nursing care daily, and she's going to do this with no medical training. Is that really what she thinks she can do, do you suppose? You don't think, for example, that she might be counting on nursing support, or at least ask for training herself? She can't be less aware than you are of your parents' needs, surely.
That doesn't mean you're wrong. Your parents might well be safer and better off looked after in the right kind of facility. And it is certainly hard to see how this would not be an overwhelming burden for your sister. But if she is starting out from a 'where there's a will, there's a way' point of view, telling her she's an idiot who hasn't considered her parents' safety is not likely to win her over to a more practical approach.
You have time in hand. I assume your mother is currently living at home and is cared for by your sister? Keep your counsel for the time being, and see how things develop. Depending on what progress your father makes, what assessment is made of his needs when people start discharge planning, what resources your sister is able to access and all the rest of it, then either a practical plan for home care will emerge, or it will become all too clear that the dual responsibility is too much for one person.
So start by listening and gathering information. Feel free to ask questions. Be open to the various possibilities. If, as the time for your father's discharge approaches, you still have concerns about the welfare of one or more of the three of them, voice them. But if you want to help, then don't start out from the premise that your sister is wrong.
When I saw it done by a respiratory therapist, I knew I could never do it myself; my father gagged and choked and it was so unpleasant for him.
If your sister plans on doing this alone, she's in for a rude and exhausting awakening. It'll drain her physically and emotionally and very, very quickly.
However, when we were going through this experience, I did a lot of research and found a forum for people dealing with trachs; some of them were parents whose children had trachs. I don't recall specifically but I believe that some of the children were at home and their parents had learned how to handle and care for a trach. Again, this is just best recollection. This is really not an easy task to handle at home because of the sensitivity of the suctioning process.
What was the reason for his being trached? Does that reason still exist?
Is your father getting videoscopic swallow exams? These will reflect whether or not frank aspiration (fluid going into the lungs) exists. In our experience that has to be resolved before he can eat orally, or he would just aspirate the food into his lungs, which can cause aspiration pneumonia.
It's been about 11 years since I went through this, and I don't remember the specific criteria for removing the trach. But tube feeding was necessary even after that, until the swallow test could be passed and reflect no aspiration was occurring.
As to the feeding tube, that could be handled by someone w/o professional medical training, but some limited training would be required. I did it for a few months and grew more confident after the first few times, the initial time being done under the supervision of a nurse.
Is he getting any speech therapy from a speech pathologist? That's one of the keys to being able to eat orally again. There are specific exercises that can be done for the swallowing muscles; they're not easy, but they were the key to oral consumption again for my father.
All nutrition is done through the feeding tube, in my father's case, every 4 hours, then through connection to an IV type machine which pumps the fluid into the tube overnight.
One serious drawback to handling this alone at home is that when we were in this situation, Medicare would only pay for a standard sized bag in which to pour the liquid nutrition. Thus, the script requirement for 6 cans overnight had to be broken up: 4 cans about 6 or 7 pm, then the balance when the pouch had drained enough to add the remaining cans.
That meant that in addition to feeding every 4 hours, I had to stay up until around 1 am when the bag was empty enough to add the remaining fluid. Then it was back up again to start all over at 7 am.
That was a grueling schedule; it wore me out very quickly. With 4 hour feeding schedules, everything had to be planned around that....med appointments, home care visits, shopping, whatever. Exhaustion was a constant companion.
If your father can be decannulated and the trach tube removed, AND if he can pass a videoscopic swallow test, he has a much better chance of adapting to home care, unless there are other issues (which I suspect there are), that require long term care.