Supporting residents in care homes with dysphagia (swallowing difficulties) is a key element for the Enhanced Health in Care Homes (EHiCH) project. The framework states that best practice will provide access to specialist Speech and Language professionals as part of the extended Multi-Disciplinary Team (MDT).
Dysphagia affects more than 51% of elderly residents in care homes and 13-57% of people with dementia (RCSLT, 2018).
Its presence is associated with:
- reduced quality-of-life of the individual and/or carers
- increased social isolation
- hospital admission
- increased length of hospital stays and subsequent costs to health and social care.
With regards to those in care homes, “the identification of dysphagia, its type and severity is essential in reducing risk of pneumonia, mortality, poor outcomes, costs and reduced well-being” (RCSLT, 2018)
Speech and Language Therapists (SLT) provide specialist assessment and advice for people with dysphagia. The Adult Community Team as part of the wider Sheffield Speech and Language Therapy service provide personalised care for people with dysphagia in care homes. Intervention usually comprises assessment, advice, targeted intervention, signposting, and onward referral.
The aim of the intervention is to reduce the risk of dysphagia related choking, aspiration, malnutrition and/or dehydration.
Managing dysphagia effectively in a care home setting requires the collective contribution of both health professionals and care home staff. Everyone working in a care home needs to know what dysphagia is, the risks involved, and who to alert if they notice a problem:
- Cooks need to be familiar with knowing how to prepare the range of texture modified diets following the IDDSI framework.
- Carers can help to improve a resident’s safety and experience during mealtimes through their understanding of dysphagia and strategies that support safe eating and drinking.
- Senior care staff, nurses and team leaders take responsibility for the close monitoring of residents with dysphagia ensuring that problems are managed in the care home or appropriately escalated e.g. through referral or discussion with SLT for advice. They also have a role in supporting and educating less experienced staff to ensure consistent good practice across the home.
- Care Home managers and senior managers within provider organisations should have a good awareness of how the needs of residents with dysphagia are being met within the care home setting (both care and catering) including preparation of appropriate and appetising texture modified diets and thickened drinks, need for specific training for carers in assisting residents and provision of equipment needed.
There should be mechanisms in place to monitor and audit practice
As Speech and Language Therapists working with the EHiCH project team, we are keen to improve dysphagia management for residents in Sheffield care homes through a shared approach.
- Contribute to improving information sharing/communication with all members of the virtual MDT who support care home residents with dysphagia.
- Consider the sustainability of allocating care homes to a named SLT and aligning allocations to Primary Care Networks (PCNs).
- Develop a new SLT dysphagia support offer to care homes, building on learning from existing service delivery and previous projects undertaken by the Adult Community Team.
- Work collaboratively with dietetics including developing a network of dysphagia/nutrition champions in the care homes.
- Work collaboratively with stakeholders to work towards dysphagia/nutrition training becoming a mandated part of the service specification contract for care homes.
For further information, please contact either Helen Hughes or Elizabeth Barnett (Specialist Speech and Language Therapists for EHiCH)
Helen Hughes: [email protected]
Elizabeth Barnett: [email protected]