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

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

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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 carry- over,
  poor compliance and high default rate

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Extent of problems

• A) 24 of out-patient speech therapy referrals
  are OAH residents
• (Survey by ST Department, RHTSK, from Oct, 2000
  - March, 2001)

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Extent of problems

• B) 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)

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Extent of problems

• C) Average time spent for transportation by NEATS
• 168 minutes
• (Survey 1 - 28 February, 2001 in ST
  Clinic, RHTSK)

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BREAKTHROUGH
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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

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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

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Preparation Work

• Educational materials
• Risk identification and swallowing management
  protocol
• Service guidelines
• Referral guidelines

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Programmes

• Education
• Educational Talks
• Practical training
• On-site consultation
• Swallowing Assessment
• Intervention
• Swallowing management guidelines
• Carer Education

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CST Coverage

• 11 Old Aged Homes
• (6 PNHs and 5 CAHs)
• under CGAT coverage
• 1692 residential places
• Inclusion criteria
• - Patients of the 11 OAHs
• - Medical referral required

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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

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Outcomes

• Education
• 2 major education programs

2002
2005
Train-the-trainer Dysphagia Management
Enhancement Program
Swallowing Management Refresher Course
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Outcomes

• Education
• - satisfactory results from post-talk
  questionnaire survey
• - increase the level of awareness, risk
  identification and swallowing management skills
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Swallowing Outcomes
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Swallowing Outcomes Change in diet to sustain
oral feedingApril, 2005 to March, 2006
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Escort hours and NEATS cost saved in 2001 (pilot
project1/2 year)
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Cost of CST

• (W.Y. Leung, 2004)
• Cost per patient treated
• Cost of CST service lt Cost in OPD, ST
• (556.2) (893.5)

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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 OAHs 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?
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Service Evaluation

• Any Policy to enhance the swallowing compliance?

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Thank You!