Dining with Dignity

Experiences of a Speech-language Therapist Working in Aged Care

RENEE TAYLOR

SpeechLanguage Therapist

y name is Renee Taylor, and I am a Director and Clinician at Swallow and Speech Therapy Consultants Ltd. I work as a consultant to the Pure Food Co, which specialises in texture-modified foods, and I am also a freediving instructor in my spare time.

My work experience includes being a Professional Teaching Fellow and sitting on the Speech-language Therapy Executive Board both in the Māori and Cultural Development and Communications roles at the University of Auckland. Additionally, I work as a community SLT for Counties Manukau DHB. My passion lies in dysphagia, particularly in older adults in aged care settings. I am committed to driving change for our most vulnerable to dine with dignity.

When I introduce myself as a Speech-language Therapist (SLT) to my patients, they often respond with confusion, saying, “But there’s nothing wrong with my speech.” It gets even more perplexing when I tell them I am there to assess their swallowing difficulty. This interaction significantly represents the need for more awareness and understanding of our role in the healthcare industry, especially in aged care settings. This confusion needs to change.

My daily work involves helping our elderly to eat and drink comfortably and safely in residential care settings. My goal is to increase the enjoyment of mealtimes while ensuring safety at the same time. Swallowing is a beautiful system that allows food to enter your mouth and be safely passed into your stomach to nourish and fuel your body and soul. We chew, taste, and experience unique textures and flavours.

Eating and drinking are central to so many cultures and social environments as they provide physical and mental nourishment, and this doesn’t change as we age. When it works well, we swallow automatically without even taking much notice. However, it can be dangerous when it goes wrong, and the pleasure around mealtimes can be significantly compromised.

Various factors, such as Dementia, Stroke, Parkinson’s Disease, head and neck cancer, and even aging, can affect the nerves and muscles that make our swallowing system work effectively. It is the role of SLTs to support people with dysphagia when this system goes wrong.

Dysphagia can increase the risk of aspiration pneumonia and choking; shockingly, choking is the second leading cause of avoidable death in aged care. Yet, having an SLT on the team is uncommon across the sector. We often see Dietitians (DTs), Occupational Therapists, and Physio Therapists, but SLT is frequently left off the list.

It’s important to note that inappropriate modification of food and fluid can be just as detrimental to an individual as the risk of choking and aspiration pneumonia. Historically, nurses and DTs have assumed the role of ‘dysphagia care,’ The most common intervention is to “mouli” the food and “thicken” the liquid, always to a very subjective degree slop either way. However, it’s not the nurses’ or DT’s fault. It’s a job that’s historically been lumped on others because, well, who else is there to do it?

It doesn’t have to be that way. Not having an SLT creates unsafe expectations for our nursing, dietetic, and healthcare assistant staff to work outside their scope of practice. SLTs are specifically trained in assessing, intervening, and monitoring dysphagia; this is our bread and butter. However, we have yet to get a regular seat at the table.

In the meantime, our most vulnerable are left in compromising situations, both in safety and for quality of life, at the most precious time of their life.

So how do we support our older adults, our kaumatua and kuia, to dine with dignity? The solution is simple, a dysphagia screening system, an SLT referral pathway, and an SLT on the team.

Eat-10 is a good screening tool. Free and online. IDDSI.org has all the info and free International Dysphagia Diet Standards resources.

Tel: +64 212967292

Email: renee@swallowandspeechtherapy.com www.swallowandspeechtherapy.com