One topic that is sure to result in a frenzy on any SLP discussion forum is how to handle the difference between what is the safest diet for someone living with dysphagia and what the patient wants. Some SLPs are steadfast that the only diet to order is the safest diet, while others (like myself) collaborate with patients to determine the recommended diet.
While there are multiple residents’ rights as determined by the Nursing Home Reform Law and presented in the National Long-Term Care Ombudsman Resource Center, several are directly related to our role as SLPs and recommending diets for patients with dysphagia.
Residents’ Rights Guarantee Quality of Life
The Nursing Home Reform Law requires nursing homes “to provide services and activities to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident in accordance with a written plan of care that… is initially prepared with participation, to the extent practicable, of the resident, the resident’s family, or legal representative.”
Physical, mental, and psychosocial well-being should be considered together. I believe this is also how we should make our recommendations. We should consider the resident’s swallowing function, risk for aspiration, and risk for malnourishment and dehydration; but we also need to consider whether modifying a diet will positively or negatively impact a resident’s mental and psychosocial well-being.
Right to Participate in One’s Own Care
Participation in one’s own care includes participation in assessment, care-planning, treatment, and discharge, as well as refusal of medication and treatment.
We need to involve the resident, resident’s family, or legal representative in establishing our recommendations. What is important for well-being differs for each person. Being able to drink a refreshing, ice-cold glass of water may mean more to a resident than reducing risk of aspiration. Only the resident or their representative can make that decision.
Right to Dignity, Respect, and Freedom
This right includes the right to self-determination. Merriam-Webster defines self-determination as “the freedom to make your own choices,” even if they are choices we would not make.
Occasionally, I hear stories about long-term care communities that stop dysphagia treatment if a resident doesn’t agree to a restrictive diet. As SLPs we need to advocate against this practice. Treating someone with respect and advocating for their physical well-being means continuing care (if the resident wishes), even if they do not want a restrictive diet.
Considering these resident rights, I believe diet recommendations should be patient-driven. I see myself as an expert resource to help patients make the best decisions for their care. My patients are ultimately the best people to weigh the risks and benefits for themselves. I document everything and then recommend what we (clinician, patient, patient representatives) have decided.