The Environment of the Nursing Home:


The nursing home staff responsible for feeding patients often have limited knowledge of dysphagia, how to recognise it and how to manage feeding safely (Kayser-Jones & Pengilly, 1999; Curfman, 2005). This can result in feeding that is unsafe to patients.

Lacking sufficient knowledge of dysphagia, nursing home staff may perceive the patient with dysphagia to be uncooperative when he refuses food or lazy when he neglects to chew or takes a long time to swallow (Kayser-Jones & Pengilly, 1999). Lack of knowledge may also result in patients not being positioned safely for feeding (e.g., being fed in a semi-reclined position).

An additional challenge within the nursing home environment is that staff often feel pressured for time during mealtimes because of the number of patients needing assistance. This results in the tendency of staff to give patients “large, unmanageable bites of food and [force] them to eat quickly” (Kayser-Jones & Pengilly, 1999, p. 79).

A further challenge within this environment is that staff turn-over can be frequent; resulting in new staff not being aware of a patient’s feeding needs (Kayser-Jones & Pengilly, 1999). It may be pertinent for the SLT to place written feeding instructions at each patient’s bed to ensure safe feeding procedures are followed (see Boaden & Walker (2005) for templates).

Other useful strategies that may be helpful for ensuring patients receive adequate and safe care are: Swallowing ... on a plate: A training package for nursing home staff caring for residents with swallowing problems (discussed by O'Loughlin & Shanley, 1998) and Dining with Dementia (Griffin et al., 2009). Next Page