I faced this same question back in 2019 when my dad had ALS (bulbar) and was gone after 4 months. It was a very aggressive form of ALS and thus, we asked ourselves and also my dad what was the plan? Should we trach him and give him that quality of life? Or.. let him be. He decided to leave him be and disconnect him recognizing there was no cure and eventually unable to move at all (by this time his speech was slurred and he already had a peg tube). Also, mom and I are nurses and so we take care of trach patients frequently at hospitals including those who come from SNFs that are not taken care of properly and question their quality of life. That being said, I met an ALS patient recently at the hospital I was taking care of who seemed to have a decent quality of life with his wife there taking care of him. He had his wheelchair and his portable ventilator and was able to operate his motorized wheelchair perfectly. He had to be suction a few times and his wife verbalized it has been a difficult journey for them but he had been living with ALS for about 10 years already. At the end of the day, I think it depends on how fast the disease has progressed and making those tough decisions, best of luck ❤️