When your loved one enters hospice care there are myriad elements that come together to focus on their well-being during the end-of-life. At Heart to Heart Hospice, our care team is made up of nurses, physicians, hospice/home care aides, spiritual and bereavement coordinators, social workers, dietitians and specialized therapists. All of these experts are important to your loved one’s care.
When it comes to hospice care, the medical experts are the people we most look to for answers, next steps, and reassurance. However, sometimes the use of specialized therapies can be helpful in improving comfort and quality of life. According to Medicare,
“Physical therapy, occupational therapy, and speech-language pathology services may be provided for purposes of symptom control or to enable the individual to maintain activities of daily living and basic functional skills.”
Unfortunately, most hospice patients receive care for such a short time (>50% receive care for 17 days or less), so there is little time to assess and treat with such therapies. When a patient enters hospice care earlier, doctors and nurses can determine if specialized therapies can help a patient maintain activities of daily living with additional help. In the case of speech therapy, the simple function of swallowing may be the key to good pain management or continuing to eat solid food.
General Functions of Speech Therapy
Speech therapists focus on three areas of treatment: functional communication, cognitive communication, and Dysphagia treatments.
Functional communication depends on factors like the nature of the patient’s disease, as well as daily fluctuations in ability and level of alertness. The therapist focuses on both auditory comprehension (being able to understand the words being communicated to them) and expressive communication (wants, needs, pain, issues, etc.). If the patient becomes or is non-verbal, systems can be developed to help them communicate pain levels, discomfort, or other issues.
Cognitive communication is how the patient processes the communication given. It’s not enough to understand what words are being said, the patient must also understand what the information means. Oftentimes, patients enter hospice care suffering from Alzheimer’s, dementia, or another degenerative mental condition. A therapist can assess the patient and decide (with the patient, their family, and care team included) if care should focus on restorative or compensatory methods.
As mentioned above, speech therapists are also extremely helpful if a patient has, or develops, issues with swallowing which can hinder treatment. Obviously a speech therapist focuses on speech, but that means all the pieces that go into making speech work: the tongue, soft palate, throat, etc. These are all vital to swallowing pills and other medications, so a therapist can develop what are called Dysphagia treatments to help the patient relearn and engage these parts of the mouth to improve these functions. This treatment also provides recommendations to doctors and nurses on oral diet textures and liquid consistencies, and safety considerations with the patient’s diet.
Dysphagia Treatment in Hospice
Dysphagia is a term that refers, simply, to difficulty swallowing. Specifically, dysphagia covers ongoing difficulties with swallowing, and not just the occasional issue. Patients entering hospice often have these issues. There are different types of dysphagia as well depending on which part of the process is effected:
Oral dysphagia – difficulties with the mouth and movements of the tongue
Pharyngeal or oropharyngeal dysphagia – difficulties with food passing through the throat
Esophageal dysphagia – difficulties with food moving down and through the esophagus
These issues are seen most often with hospice patients suffering from disorders associated with muscle weakness and coordination such as ALS, Parkinson’s, or a stroke. It’s also seen with certain types of cancers that affect the esophagus and mouth.
Once the speech therapist is able to study the patient and understand the issue, they can offer options to the doctor and nurses to better address problems with eating and taking medications. They’ll determine if a thickening agent is needed to prevent choking, or if food must be pureed or liquid medications prioritized. This helps the entire hospice team plan, or adjust, a course of action for the patient that best benefits them and the treatments recommended.
Speech Therapists are Key During Hospice Care
The emotional and mental impact of entering hospice care cannot be understated — not only for the patient but for their families. This is why communication is so important for everyone involved. However, just as important is the care team’s ability to administer a treatment plan, and if the patient is having issues taking important medications it can be a problem. That’s why the role of a speech therapist is so important. Their ability to diagnose issues within the mouth and throat can greatly assist the medical team with treatment options focused on the patient’s quality of life.
