Enhancing the Quality of Care for Old-Aged H ome Residents with Dysphagia Through a Com munity Speech Therapy Pilot Project in the Ho ng Kong East Region Speech Therapy Department Ruttonjee and Tang Shiu Kin Hospitals Candy Ngan (Speech Therapist i/c) Rita Wong (Speech Therapist) Christina Chan (Speech Therapist) Jamy Wong (Clerk)
Background Problems encountered at out-patient ST clinic Patient:frail elderly, chair-/bed-bound with transport problem OAH staff: inadequate knowledge on risks prevention and swallowing management Speech Therapist: face with poor carryover, poor compliance and high default rate
Extent of problems A) 24% of out-patient speech therapy referrals are OAH residents (Survey: by ST Department, RHTSK, from Oct, 2000 March, 2001) Extent of problems B) 8.5% (119) OAH residents require non- o ral feeding 9.1% (128) OAH residents (on oral feedin g) were reported to have swallowing diffic ulties
(Questionnaire Survey to 14 OAHs in HKE region) Extent of problems C) Average time spent for transportation by NEATS = 168 minutes (Survey: 1 - 28 February, 2001 in ST Clinic, RHTSK) CST Pilot Project
Community Speech Therapy (CST) service for HKE commenced in May, 2001 Aim: enhance service quality and outcomes to OAH residents with swallowing problems Preparation Work
Liaison work with - CGAT, HKE - OAH in-charges - Medical and Geriatric teams of other hospitals in HKE through our CGAT - Speech Therapy Department of PYNEH/TWEH/WCHH - Finance Department Preparation Work
Educational materials Risk identification and swallowing management protocol Service guidelines Referral guidelines
Programmes Education Educational Talks
Practical training On-site consultation Swallowing Assessment Intervention Swallowing management guidelines
Carer Education CST Coverage 11 Old Aged Homes (6 PNHs and 5 C&AHs) under CGAT coverage 1692 residential places Inclusion criteria: - Patients of the 11 OAHs - Medical referral required
Present Progress (April, 2005 to March, 2006) Manpower: 0.2 speech therapist FTE Total new attendance: 160 Total attendance: 558 No. of residents who had completed
swallowing intervention by ST in April, 2005 to March, 2006 = 137 Outcomes Education 2 major education programs 2002 Train-the-trainer Dy sphagia Managemen
t Enhancement Prog ram 2005 Swallowing Management Refresher Course Outcomes Education - satisfactory results from post-talk questionnaire survey
- increase the level of awareness, risk identification and swallowing management skills " nursing home, , ; . , ." "
, . " " 29-5-2001 , , , , . " Swallowing Outcomes Mode of feeding 4/2005 to 3/2006 Oral Oral 67%
Non-oral Non-oral 21% Non-oral Oral 4% Oral Non-oral 8% Swallowing Outcomes
Change in diet to sustain oral feeding April, 2005 to March, 2006 Upgrade 33% Downgrade to dysphagia diet 31% No Change
36% Escort hours and NEATS cost saved in 2001 (pilot project1/2 year) C&AH staff PNH staff Escort time saved 160 hours
390 hours NEATS cost saved N/A HK$ 37,720 Cost of CST
(W.Y. Leung, 2004) Cost per patient treated: Cost of CST service < Cost in OPD, ST ($556.2) ($893.5) Service Evaluation OPD
Demand of frail elderly, be Escort problem No need to escort to the hospitals One resident, One OAH -at least 3-5 patients per OAH
visit - recruit 2-3 OAHs within clos e geographical region The escort staff might not be the one who cares the residents Difficult to carry-over the swallowing recommendations Could provide on-site
education and hands-on practical experience for the front-line staff. Know the staff quality of the OAH tailor-made the mode of education to them Not know the compliance of the residents in OAH
Know the compliance of the residents in OAH - good? - poor? d-bound residents with dysph agia Cost-effectiveness limited time and resources - Caseload
- Staff quality -high turnover rate of OAHs staff - language barrier Swallowing compliance
CST Service Evaluation Any Policy to enhance the swallowing compliance?
