Enhancing the Quality of Care for Old-Aged Home Residents with Dysphagia Through a Community Speech Therapy Pilot Project in the Ho

ng Kong East RegionSpeech 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)

BackgroundProblems 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 carry-over, 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 problemsB) 8.5% (119) OAH residents require non-

oral feeding

9.1% (128) OAH residents (on oral feeding) were reported to have swallowing difficulties

(Questionnaire Survey to 14 OAHs in HKE region)

Extent of problemsC) 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

Train-the-trainer Dysphagia Management Enhancement Prog

ram

Swallowing Management Refresher

Course

2002 2005

OutcomesEducation- satisfactory results from post-talk questionnaire survey

- increase the level of awareness, risk identification and swallowing management skills

" 現時的 nursing home, 極需要這種訓練給予員工 ,讓員工 對吞嚥困難之長者護理有深刻認識 ;但各員工因無時間 往上課 .現在有此機會 ,極為珍惜 ."

" 現時一課內容很實際與本院內之長者之需求協助有密 切關係 ,直接幫助到現時部份老人家之需 . "

" 經過 29-5-2001 這一課 ,實在得益很多 ,有錄影帶播出 ,對 課程內容更加深入理解 ,下次講座也希望會帶帶播影 . "

Swallowing Outcomes

Mode of feeding4/2005 to 3/2006

Oral → Oral67%

Oral → Non-oral8%

Non-oral → Oral4%

Non-oral → Non-oral21%

Swallowing Outcomes – Change in diet to sustain oral feedingApril, 2005 to March, 2006

Upgrade33%

No Change36%

Downgrade todysphagia diet

31%

Escort hours and NEATS cost saved in 2001 (pilot project—1/2 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 CST

Demand of frail elderly, bed-bound residents with dysphagia

Escort problem No need to escort to the hospitals

Cost-effectiveness- limited time and resources- Caseload

One resident,

One OAH

-at least 3-5 patients per OAH visit

- recruit 2-3 OAHs within close geographical region

Staff quality-high turnover rate of OAH’s staff- language barrier

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

Swallowing compliance Not know the compliance of the residents in OAH

Know the compliance of the residents in OAH- good? - poor?

Service Evaluation

Any Policy to enhance the swallowing compliance?