If you work in skilled nursing and haven’t read this article in the latest edition of The Leader, you’re missing out. ASHA recently published, “Speak the SNF Lingo to Show the Need for Instrumental Assessments” which provides a wealth of knowledge. I am going to share some highlights and add in my experiences. Go read it and come back here. 

“SLPs might be well-versed on the evidence and recommendations driving the use of instrumental assessments, yet they may not know how to express them to administrators whose primary—typically business-driven—concerns differ from their own.” 

This is very true. Most administrators are not going to know the in’s and out’s of dysphagia and why instrumental assessment is so important. You might be the first SLP to really push for use of instrumentals, so they might not understand why you need them but the last SLP did not. That’s where we delicately share how instrumentals are not optional and the last SLP probably should have been asking for them as well. It’s our job to show them the evidence and to explain why FEES and MBSS are non-negotiable for the best care for their residents. Need evidence? Reach out and I will give you what you need!

“However, in the short term, SNF administrators may question the value of sending a patient for a study they perceive as having little benefit in relation to cost. Why invest in a swallow study, some might think, when you can simply put the patient on thickened liquids and a modified diet if you suspect a swallowing problem—or limit an SLP’s tools to just a bedside assessment of swallowing (which cannot provide adequate information about swallowing physiology)?”

Here is where you share the cost of thickened liquids (up to $7000 a year per patient) and the cost of tube feedings (hundreds of dollars each day). You can also hit them with the average of $30,000 for a hospital admission related to pneumonia. That FEES exam will suddenly seem very affordable. This is not to say that all administrators only care about money. That is far from the truth. I have met with many administrators that just want the best care for their residents regardless of cost. 

The article lists some great conversation starters and advice for SNF SLP’s. My favorite piece of advice is to reach out to your local mobile FEES provider (Hey there!). As a mobile provider, I have spoken to many administrators and have the answers they want. I love getting the instrumental studies to the people that need them so do not ever hesitate to reach out for advice, resources, or to set up a meeting. I’ll even bring the snacks! 

#ScopeOn 

Here’s the link to the article: https://leader.pubs.asha.org/do/10.1044/leader.FTR1.26062021.46/full/