Refusing trach care

Hi.

I don't really have a specific question. I'd like to post a bit of information in hopes that someone might have some input or advice on it.

A resident has a tracheostomy. No trach tube just the stoma, but it does function as their airway. No oxygen system - room air- no added humidification. No suctioning ordered. Does have orders to 'flush stoma q shift with saline'.

Resident is confused and very combative at times when attempts made to examine area or assess. Frequently refuses any care of area and any interventions. Refuses to allow nurse to even look at it sometimes and will pull shirt over it to conceal it.

Generally able to expel any mucous by coughing and the main need is to keep stoma clean, but sometimes refuses care completely until airway is affected by built up mucous and dried secretions. This is my biggest concern, that there is usually a problem before anyone is allowed to intervene and I am afraid that it will lead to an emergency situation.

I do document his agitation and refusals, any tidbits of an assessment I can get, and the care measures that I am able to provide.

I have little experience with trachs, but that probably shows right?

If anyone has any suggestions for this I would love to hear them.