Hey Allen - good to hear your wife is scheduled to see an SLP next week. The sooner the better! I hear of an awful lot of people who are seen by SLP's for consults rather than actual treatment. I think we're missing a big opportunity to progress by not truly treating these problems. Talk with your SLP about a treatment plan rather than a "wait and see" approach - same thing for respiratory therapy.
As an SLP, I've worked with many similar cases. Here's the thing about breathing - if it doesn't come easily then we reflexively freak out a bit which leads to - you guessed it - increased difficulty breathing!!! With treatment, a person can be well monitored for appropriate oxygenation while they work with the therapist to build their tolerance for the cap and learn to relax a bit and better manage their own respirations - leading to increased likelihood of de-cannulation (trach removal)

These things can improve with treatment - same for your Mom, Trish!

Most insurance plans cover speech therapy.

Good luck!