Some people apparently do get sent home with the trach still in. In my case, I stayed in the hospital until it was removed, and I could prove that I could eat enough calories on my own, without the feeding tube. In my experience, the trach started out with a larger opening and as I started to heal, they replaced it with a smaller and smaller insert. Suction was required quite often initially, but it also had to be done less often as I healed.