Maximising Your Speech Pathology Referrals

January, 2020

A Speech Pathologist’s role in the Aged Care Setting is primarily focused on dysphagia (difficulties chewing and swallowing food and drink), and ensuring our residents are safe during all oral intake. It is a Speech Pathologist’s goal to consider not just the difficulties a resident may be having, but their cognitive abilities, insight, and quality of life. All of these elements play a part in providing a recommended diet texture- remember, a Speech Pathologist will aim to avoid texture modification if safe to do so!

In order to ensure we provide the safest recommendation for each resident, we require several key pieces of information that will help us piece together the puzzle in front of us, and consider each resident holistically. These include:

Case history: Does the resident have a history of head and neck cancer and radiation therapy? GORD/Reflux? COPD? Parkinson’s? MND? These are just a few conditions that can have an impact on our every day swallowing mechanism.
Swallowing history: Has the resident required a modified diet previously? If so, why? Do they have a history of swallowing difficulties?
Recent changes in presentation: Has the resident been more confused or irritable recently? Have they been experiencing delirium? Have they recently had a general decline, or could they have a UTI? Could they be unwell?
What is the concern: Do they have difficulties on certain textures? If it’s food, is it meat- a chewy, sometimes tough consistency? Or is it difficulty tolerating bread and toast- a soft and sticky consistency?
What happens: Can they chew it? Do they spit it out? Cough? Choke?
Has an incident occurred: Has the resident experienced throat clearing, a coughing fit, or choking? Was QAS called?

Having this information readily available for your visiting Speech Pathologist will ensure their assessment takes place in a thorough and time efficient manner. There are several ways that you can assist your Speech Pathologist when you send a referral through. These include:

Identification: Please ensure you write the resident’s name correctly- including a room number can help as well.
Reason for referral: this is important, as we may not be able to identify the cause for referral while on site. Please do not rely on your staff or the resident themselves to provide information to the Speech Pathologist. Staff are often busy, and residents can be forgetful.
Current diet: What diet and fluid levels are they currently on?
Diagnoses: If a resident has a diagnosis that you think might be relevant, add it in to your referral.
Incidents: Please include information on any incidents that may have occurred. For example, if the resident is having difficulty tolerating a Level 6 Soft and Bite Size diet, please let us know if they are experiencing coughing or choking when they eat it.
Diet modifications: Has their diet been changes as a result of this incident? Has the RN downgraded their diet? If so, are they tolerating it?

Including the information listed above will help us determine how urgent a referral may be. This will help us plan out our weeks by prioritising our list of referrals, while also ensuring we allocate the necessary amount of time at each site. Leaving out important information increases the time a Speech Pathologist is on site, as we have to locate staff familiar with the resident.

Additionally, it prevents any mix-ups such as a Speech Pathologist assessing if the resident is safe on their diet, when they were actually referred because they are wanting toast. Below is a template for use if staff feel they may forget to include information.

“Hello Speech Pathologist,
Please review “John Smith” in room 01. Recently he has been coughing whenever he eats meat. He is currently on a Level 7 Regular diet, with Level 0 Thin fluids. John has a history of GORD and COPD, however the staff have noted that this cough sounds a little different. He has had 2 coughing fits now which left him short of breath and his face changed colour. We didn’t need to call QAS as he settled, however his diet has been downgraded to a Level 6 Soft and Bite Size diet with Level 0 Thin fluids until reviewed. He appears to be tolerating this well and has not been observed to be coughing on it.”

Dietitians Australia

Don’t let your residents or budget experience the side effects of malnutrition or dysphagia.
Call us on 1300 850 246 or email and request a call back.

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