The overall aim for long-term tracheostomy care is to help those with respiratory failure to achieve a high-quality active life. A long-term tracheostomy does not necessarily mean an increased need for hospital care. With an optimally fitted tracheostomy tube, patient and staff education and regular follow-ups, serious complications can be avoided. This article describes predictors of good long-term tracheostomy care, such as tube selection, indications of change and follow-up.