The Interdisciplinary Role of the Speech-Language Pathologist in Senior Living Community Engagement

By Christina Bracke, MS, CCC-SLP
Speech-Language Pathologist

Speech-language pathologists are individuals who have obtained a master’s degree and clinical certification in the study, diagnosis, and treatment of disorders impacting communication between individuals. Communication may be written, spoken, or gestural and involves many cognitive processes within the brain. SLPs are able to work with individuals of any age including the geriatric population. This includes those who are no longer able to live independently and have moved to a senior living community, assisted living facility, or memory care facility. Natural aging results in changes in communication as well as an increase in the frequency of medical events which may further negatively impact communication. Skilled therapy and the services of an SLP are some of the many tools that can be provided to an individual or facility staff member to support these changes.

Undoing the Misconceptions of the SLP’s Role

When you hear the words “speech-language pathologist” or “speech therapy” the first thought that comes to mind is most often “I can talk, what do I need that for?” The title of the SLP is likely to be one of the most misunderstood and underrepresented titles when it comes to recognizing the job duties and role of a speech therapist. SLPs are trained in improving word and language acquisition however, the title of speech therapist encompasses multiple domains and service delivery areas. The primary objective to increase the quality of an individual’s life through communication and swallow function.

Implementation of evidence-based practice treatment through the services of an SLP can target specific areas of change in communication to maximize an individual’s lifestyle and promote gains in their overall quality of life. Communication impairments can occur at any stage of life and may manifest themselves through a variety of daily tasks and functions which can be split into two primary areas: health conditions and contextual factors. Health conditions such as abnormal anatomy, and developmental language impairments may contribute to disorders such as vocal fold paralysis, increased choking risk, stuttering, and delays in language acquisition. Contextual factors include environmental and personal factors. Environmental factors include settings we choose to participate in such as social settings and may impact hearing, language comprehension, and communication intent. Personal factors are out of an individual’s control but can result in differences in communication exchanges such as age, race, ethnicity, and education resulting in differences in communication exchanges.

Areas of Service Delivery

The American Speech-Language-Hearing Association states an SLP’s direct areas of service delivery for assessment and treatment include: fluency, speech production, language (spoken/written), cognition, voice, resonance, feeding and swallowing, auditory rehabilitation, and rehabilitation for those with hearing impairment. Within these areas, SLPs are able to complete informal and standardized assessments to determine diagnoses, areas of impairment, deficits related to one or more diagnoses, and the establishment of an evidence-based, skilled treatment plan.

SLPs play an important role in counseling, prevention/wellness, screening diagnosis, and the direct treatment of communication and swallowing disorders. SLPs are trained to provide services not only within their areas of expertise but must demonstrate knowledge and understanding in the systems related to the areas of service delivery for which they provide. As a result, an SLP can serve as a key collaborator in an individual’s care by making referrals to outside providers and health professionals such as Audiology, neurology, GI, and ENT. Counseling services may include direct counseling by your SLP to both the patient and family regarding areas of impairment, need for services, benefit from services, or care options as well as, referrals to community resources and support groups. These referrals can often provide preventive and/or supportive care increasing management of a current condition.

SLC Areas of Focus

Within senior living communities, the primary job of an SLP is to address changes related to natural aging and disease progression which may be preventing residents from maintaining independence and living an optimal lifestyle. Change in status for function may include any of the following:

• Screening new residents: what changes have led them to live here and what types if any of additional assistance do they require.
• Screening for general concerns for change in condition
• Decreased independence/safety in meal management
• A general decline in cognitive communication.
• Follow up care for residents returning from the hospital

The majority of an SLP’s caseload will consist of individuals exhibiting changes in meal management and swallowing and cognitive communication. The goal of treatment for meal management is to maximize nutrition/hydration, promote safety with eating, and meet patient preferences to maximize the ability to maintain the enjoyment of meals.

Likewise, treatment for cognitive-communication skills addresses the brain function behind a specific task and targets task initiation and execution to improve community living. While individuals within a senior living community are there due to a need for some type of daily assistance (medication management, meal prep, or completion of daily cares) the main idea is that the SLP is there to provide support and positive skills training to maximize the quality of life and decrease caregiver burden within the facility. Skilled therapy serves as a support to increase independence with daily tasks, improve engagement and return to personal hobbies, and provide optimal opportunity for community engagement.

Referral Indicators

In order to understand common referral indicators, it is important to further explore the types of tasks an individual may complete or exhibit difficulty with. In SLCs, individuals are able to establish and follow their own schedules to attend activities, engage in hobbies, and converse with other residents. These interactions may happen within their own room, hallways, or facility common spaces. Some examples of common referral indicators related to cognitive communication and swallowing are listed below:

Cognitive-Communication

• Increased falls which may indicate decreased processing and safety awareness
• Decreased ability to follow a daily routine/schedule
• Difficulty with participating in facility outings
• Increased difficulty completing simple IADLs: making a grocery list, making phone calls, navigating the television, and use of the remote.
• Decreased attendance of facility activities and difficulty following directions.
• Completing tasks with environmental distractions such as in the presence of other individuals or with music on.

Swallowing

• Increased coughing at meals
• The occurrence of emesis (throwing up or spitting up) during or directly after a meal
• Inability to control or keep food in the mouth
• General decline or refusal to eat

Any notable change or decline in a patient’s function indicates the need for further assessment by a speech therapist. Many of the above-listed indicators may demonstrate an impact on their physical skills, however, the cognitive skills and brain work behind the task are equally important. Additionally, the areas above are considered to be only the most common referral indicators. It is important to keep in mind the above-mentioned areas of service delivery that may require referral such as speech/language impairments, hearing impairments impacting any of the above, and changes in voice and vocal quality. When in doubt, it is better to report changes or concerns to the SLP so a screen can be completed and the next steps—if any—can be determined.

Interdisciplinary Collaboration

Collaboration, education, and engagement with an SLC staff are key to an individual’s care and the goal to optimize their quality of life. Interdisciplinary collaboration within an SLC requires engagement with therapy staff, caregiver staff, and NSG. An SLP should send and receive weekly to bi-weekly updates to SLC nursing staff for residents who are being seen through therapy to ensure any needs are met, changes or concerns can be addressed, and positive progress can be noted. These communications also serve the overseeing physicians who manage an individual’s medical care. Collaboration and communication regarding patient updates are important for the overall continuity of care and to address quality of life. Likewise, an SLP can provide direct support to staff through educational in-service training. These may include but are not limited to: facility diet levels and meal modifications, referral indicators, strategy training and cueing instruction, and dementia management.

Additionally, SLPs often work with caregivers to provide effective communication strategies for specific residents with whom staff may be experiencing increased difficulty. Some of the most commonly used strategies include:

• Wait and provide additional time for individuals to express their thoughts
• Use of slow, loud and clear speech
• Use of short, simple words and phrases
• Provide no more than 2-3 step directions at a time
• Avoid additional distractions when possible
• Speak to the individual face to face

As you can see, SLPs serve the residents, management, nursing, and caregiver staff within an SLC in a variety of capacities and are not limited to treatment services. Establish a positive relationship with your therapy team and most importantly, remember that your SLP should always be considered a resource available to assist in providing support to you, your residents, and staff.