Elizabeth Newman
Elizabeth Newman

There’s a running joke among many journalists I know that concludes: For people who communicate for a living, sometimes we do a bad job communicating.

This occurred to me while reading and watching videos this week on speech language pathologists’ swallowing assessments. Difficulty swallowing, or dysphagia, is a common result of a stroke, and is a common problem among long-term care residents. While the mechanics of evaluating swallowing struck me as straightforward, I had a question I can’t believe I never asked before.

How do you discuss a speech or swallow-care plan with someone who might not be able to communicate well?

I turned to Friend of McKnight’s Renee Kinder, a speech language pathologist with Evergreen who blogs for us regularly. To give you a sense of how committed she is, I shot her this query at about 9 p.m on a Monday and got an answer back in 15 minutes.

Kinder said it was a good question “because while someone may have a cognitive or language impairment that affects ability to understand the changes in swallow, it is the care provider’s responsibility to do due diligence in improving their understanding.”

She gave me the scenario of having to change what the resident is eating. If the SLP hasn’t made sure the resident understands on a basic level what’s going on with swallowing, “the tray comes in the next day for breakfast, and in place of the coffee, sausage and toast is pureed eggs and thickened juice. This is the worst-case scenario.”

A resident has a right to keep eating a diet when he or she is at risk for aspiration, even if the facility finds this risk/benefit process cumbersome, Kinder says.

For me, I’m not sure I would consider life to be worth living if I couldn’t ever have ice cream, hard cider, or my husband’s homemade chocolate chip cookies. That said, I’d feel differently if I had a stroke from which I could recover. We also need to understand the difference between choking — a horrible event causing pain — and aspiration, which can lead to aspiration pneumonia. If you are a long-term care resident with dementia, arthritis and low quality of life, the latter is arguably not the worst way to depart this life.

Evaluating aspiration risk, swallowing and a resident’s desire to eat bacon is about more than liability: It’s also about that phrase bandied about every day, which is “resident choice.”

It’s tricky, evaluating this preference with risk, and I hadn’t stumbled on a new issue or question, of course. There’s an entire field of Augmentative and Alternative Communication in research, practice and policy. And the technology is only going to continue to develop. AAC can be an ideal way to curb dangerous non-verbal communication, such as hitting or spitting. That said, there’s a fair amount of focus on children, and long-term care doesn’t have a superior track record of embracing technology quickly.

But for those entering the field, remember that AAC doesn’t have to mean super-fancy electronic devices — it can include visual aids such as an alphabet board or Yes/No cards. SLPs also can interpret verbal cues, such as a resident nodding. They use slow and simple speech to help understanding of oral function, and can help other clinical employees in improving communication.

And after they do that, maybe offer them a cookie.

Elizabeth Newman is Senior Editor at McKnight’s. Follow her @TigerELN.