Transcript Counseling in the Acute and Post

SPHP 219 class:
 Any slides with asterisks are NOT on the exam 
Working with Adults**
Geriatrics vs Pediatrics?
Does the setting in which adults are being treated make a
difference?
Post-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 Facilities
Assisted Living Facilities
Assisted 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 Health
Home Health
Home 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 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 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**
 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?