The Team
Much of the following information comes from Crary and Groher (2003).

Nursing Staff : Within the nursing home, nursing staff are responsible for 24-hour care of individuals with moderate-severe dementia and dysphagia.
They are responsible for:
· Safe eating positions at mealtimes.
· Making the person aware that it is a meal time and you are about to start feeding them.
· Ensure the amounts in a mouthful is manageable,
· Reminding person to chew and swallow,
· Ensuring they are not storing food in their mouth or further back.
According to Volicer & Hurley (1998) cueing is regularly required to remind individuals to chew the food or swallow. To help initiate a swallow, gently stroking the throat can be very effective. Regular and thorough oral care is incredibly important. They are responsible for informing visitors (who have limited or no knowledge of the individuals' dietary restrictions) of dietary restrictions so that no food gifts inadvertently cause choking and/or aspiration.
Nurse Aids: Assist nursing staff by assisting individuals in the nursing home with activities of daily living. In some facilities nurse aids may not be formally trained.
Speech-Language Therapist: Assess safe swallow and food/fluid consistency and develop individualized management plans. Often the SLT will also be responsible for coordinating the swallowing team.

Within the nursing home setting, the primary team members working with SLTs are registered nurses (RNs) and nurse aids (NAs) (O’Loughlin & Shanley, 1998). Access to other multidisciplinary team members typically found in the hospital setting (such as occupational therapists, physiotherapists and dieticians) may be limited due to financial constraints.

Occupational Therapist: Provide adapted utensils if need be.
Dietician: Assesses and monitors the individual's hydration and nutritional levels to ensure the individual's dietary needs are being met. It is important to work closely with the dietician to ensure dysphagia management involves adequate caloric intake. the dietician may provide supplement drinks, for example, if individual requires more calories than they are getting. The Kitchen Staff: They are indirectly involved but play an important role with regard to preparation and delivery of the drinks and meals according to each individuals' specific mealtime needs. As mentioned in the 'intervention' section food should ideally be served hot or cold, not luke warm and should have strong flavours.
Gerontologist: Facilitates the acute inpatient treatment and discharge plan, if individual is admitted to hospital with a lower respiratory tract infection or other medical concern.Radiologist: Are involved during videofluroscopy assessment (dynamic imaging) and other general x-rays.The Family: While not a multidisciplinary team member, the family can provide invaluable information about the individual with moderate-severe dementia and dysphagia - particularly during assessment when gathering a case history. Plans should be discussed in collaboration with the family.Next Page