Improvements in technology have allowed people with tracheostomies to live at home on mechanical ventilation (HMV). Quality of life (QOL) for HMV users has been studied quantitatively, but few qualitative studies have been published. The purpose of this phenomenological study was to explore QOL for individuals with tracheostomies on prolonged HMV focusing on activities of daily living (ADLs) and the role of decision- making. The Roper, Logan, and Tierney activities of living theory were used to categorize activities. Ten participants, 18 years and older, with a tracheostomy and on HMV for at least 6 months were enrolled using purposive sampling. Data were collected through structured, in-depth, face-to-face interviews. Themes that emerged were (a) autonomy, (b) significance of ventilator for well-being, (c) feeling tied up, (d) creating meaning, (e) tipping point, (f) reminiscence, (g) building trust and confidence, (h) adjusting to technology, (i) family support and relationships, and (g) meaning of life. The participants were relatively healthy and their QOL was improved when they were on HMV compared to the hospital. The participants felt empowered that they had control in their daily lives at home when they had competent caregivers and family members for continuity of care. Recommendations for future research would include exploring improved methods of collaboration among health care workers and families in providing holistic care and reducing role strain and isolation in young HMV users. The study may promote positive social change through education for family, health care workers, and the public about strategies to promote independence and subsequent improvement in QOL for individuals on HMV.