SPHP 219 class:SPHP 219 class:  Any slides with asterisks are NOT on the exam

Working with Adults**Working with Adults** Geriatrics vs Pediatrics? Does the setting in which adults are being treated make a difference?

Post-Acute SettingsPost-Acute Settings  Long Term Acute Care (LTAC)  Skilled Nursing Facility (SNF)  Assisted Living Facilities  Home Health

LTAC  Post-Acute, but patient required intensive medical care  Tracheostomy & Ventilator Needs  Severe CVAs with global effects  Rehab (PT, OT, SLP) often a main focus  Select Specialty Hospitals  NPO, PEG Tubes, AAC, very limited language

Assisted Living FacilitiesAssisted Living Facilities

 For “residents” who maintain some level of safety at an independent level  Non-acute “residents” who need little nursing or rehab care  Typically one-bedroom apartments with private bathrooms and kitchenette  Nursing staff available on-call, or ONE nurse overnight on staff.

Home HealthHome Health

 Provides in-home healthcare services typically after an acute-care stay  Nursing, Social Work, Physical Therapy, Occupational Therapy  And…Speech “Therapists.”  Give up on Speech Pathologist…lol.

Skilled Nursing FacilitySkilled Nursing Facility  Nursing Home  Split between long-term care (e.g., dementia units) and short-term rehabilitation.  Medicare and MediCAL funded.*  Rehab Driven…$$$

SNFs  Patients who need 24-hour care, but no longer need acute care.  Specific Rehabilitation needs  CVA’s, post-orthotic surgery, Parkinson’s  Patient’s admitted on short-term basis typically leave facility after completion of therapy.  Combination of hospital and home (?)

Factors Working Against SLPsFactors Working Against SLPs  Multiple health problems  Depression due to illness and current placement  Surrounding can be difficult to deal with.  Hopelessness, what’s going to happen next?  Dreaded word: NURSING HOME

Factors Working Against SLPs and Service Delivery  Children VS Adult’s  Similar family dynamics  Making a case for SLP services…people like to eat and talk…  SLP required to screen EVERY patient  Engage the patient, find about them and incorporate that into therapy.

What Not to Say**What Not to Say**  Dysphagia, Phonology, Morphology…  Mortuary  Diarrhea  Jaws of Life  Bring it down a notch

How would you explain this to a family or patient?**  Your father has severe pharyngeal dysphagia and may need a j-tube or g-tube.  What if he doesn’t get better?  What if you get a patient whose “looked of strokes online” and knows everything about strokes now?  How do you explain to a family that you just evaluated their 98 old mother and you are recommending NPO?