Long-Term Care

The number of older Americans is expected to rise from nearly 36 million in 2003 to an estimated 71.5 million in 2030, according to the Administration on Aging. One in four of us will need long-term care support some time in our lives. Therefore, the need for speech-language pathologists in the long-term care industry is expected to continue to grow.

Speech-language pathology in the long-term care setting has evolved considerably over the years. While nursing homes once were the only choice for the elderly, a variety of options now is available, such as subacute care, long-term care, assisted living and home health.

Furthermore, with the implementation of the Omnibus Reconciliation Act of 1987 (OBRA), the level of services in long-term care facilities has expanded dramatically. The regulations mandate that residents be maintained at their highest functional level and quality of life.

The speech-language pathologist is a vital part of the interdisciplinary team that determines the appropriate plan of care for each resident in long-term care. Other team members may include the resident and family, physicians, nurses, dietitians, physical and occupational therapists, and social service and recreational personnel.

Speech-language pathologists consult with team members and make recommendations regarding a resident's ability to communicate, including expressive and receptive language skills, cognitive-linguistic skills, voice and fluency.

More frequently, though, they are a critical part of the care planning process regarding the person's nutritional status, especially when dysphagia is present. Their recommendations focus not only on enhancing the communication and nutritional status of a resident but on the individual's quality of life.

Intervention begins with screening, a hands-off process that does not require a physician's order. A screen, which determines whether an assessment is warranted, includes a thorough review of the medical chart; interviews with staff, resident and family; and observation of the resident. If further assessment is needed, physician's orders should be obtained for a complete evaluation.

Evaluations should be comprehensive to ensure that all aspects of a resident's abilities and impairments are considered when developing a plan of care. The care plan should focus on what the resident wishes to achieve and be designed with success in mind.