I am struggling with our speech pathologists and some of their recommendations for our late stage dementia residents.We work very hard to educate these family members regarding the expected progression of the disease through frequent advance life care planning.A large portion of my time is spent talking about dysphagia,artificial feeding and fluid resuscitation and our goal of continuing to offer foods and fluids as tolerated.No weekly weighs,no shoving food down these folk's throats.Most of the loved ones "get it". I talk about various techniques for feeding such as alternating flavors and temps,positioning,pleasant surroundings and also encourage the family to bring in anything the resident may have enjoyed or is asking for. I have BIG problem with using ice on a resident's mouth to stimulate an oral response.I don't believe that is a very pleasant sensation for an end stage dementia resident.Am going to try it on some co-workers to see what they think
I have a BIG problem with using a baby spoon,that's a dignity issue for me.
I have a BIG problem with loudly and repeatedly instructing the resident to chew,swallow,swallow,tuck,swallow...Just does not seem pleasurable.
I'm looking for some opinions here ,I don't know if this is just an emotional trigger for me or a valid concern.I appreciate any and all comments.
In my experience in LTC, this would be up to the family/POA to decide. Most POA's for dementia patients still wanted the patient to be fed with intake goals defined. Usually these patients had a DNR in place but weren't truly "comfort care only". Some were hospice, but food intake was still a part of their care plan. If the patient became unable to swallow safely, the family was notified and feelings stopped or a "pleasure feed" order placed where the family knew feeding could cause aspiration/death. That would be heavily documented and added to their care plan.
Speech therapy can make recommendations but it's ultimately the families decision.
Each patient is so different, and quality of life would need to be factored in along with the patients functional level and aspiration risk. I think each individual patient would need to have their circumstances considered along with the wishes of the POA/family, and input from nursing/speech pathology/physician, possibly ombudsman/patient advocate.
Karou
700 Posts
In my experience in LTC, this would be up to the family/POA to decide. Most POA's for dementia patients still wanted the patient to be fed with intake goals defined. Usually these patients had a DNR in place but weren't truly "comfort care only". Some were hospice, but food intake was still a part of their care plan. If the patient became unable to swallow safely, the family was notified and feelings stopped or a "pleasure feed" order placed where the family knew feeding could cause aspiration/death. That would be heavily documented and added to their care plan.
Speech therapy can make recommendations but it's ultimately the families decision.
Each patient is so different, and quality of life would need to be factored in along with the patients functional level and aspiration risk. I think each individual patient would need to have their circumstances considered along with the wishes of the POA/family, and input from nursing/speech pathology/physician, possibly ombudsman/patient advocate.