Speech Therapy Department Ruttonjee and Tang Shiu Kin Hospitals

1. Enhancing the Quality of Care for Old-Aged Home Residents with Dysphagia Through a Community Speech Therapy Pilot Project in the Hong Kong East Region Speech Therapy Department Ruttonjee and Tang Shiu Kin Hospitals Candy Ngan (Speech Therapist i/c) Rita Wong (Speech Therapist) Christina Chan (Speech Therapist) Jamy Wong (Clerk)

2. Background Problems encountered at out-patient ST clinic • Patient: frail elderly, chair-/bed-bound with transport problem • OAH staff: inadequate knowledge on risks prevention and swallowing management • Speech Therapist: face with poor carry- over, poor compliance and high default rate

3. Extent of problems A) 24% of out-patient speech therapy referrals are OAH residents (Survey: by ST Department, RHTSK, from Oct, 2000 - March, 2001)

4. Extent of problems B) 8.5% (119) OAH residents require non- oral feeding 9.1% (128) OAH residents (on oral feeding) were reported to have swallowing difficulties (Questionnaire Survey to 14 OAHs in HKE region)

5. Extent of problems C) Average time spent for transportation by NEATS = 168 minutes (Survey: 1 - 28 February, 2001 in ST Clinic, RHTSK)

7. BREAKTHROUGH

8. CST Pilot Project • Community Speech Therapy (CST) service for HKE commenced in May, 2001 • Aim: enhance service quality and outcomes to OAH residents with swallowing problems

9. Preparation Work • Liaison work with - CGAT, HKE - OAH in-charges - Medical and Geriatric teams of other hospitals in HKE through our CGAT - Speech Therapy Department of PYNEH/TWEH/WCHH - Finance Department

10. Preparation Work • Educational materials • Risk identification and swallowing management protocol • Service guidelines • Referral guidelines

11. Programmes • Education • Educational Talks • Practical training • On-site consultation • Swallowing Assessment • Intervention • Swallowing management guidelines • Carer Education

16. CST Coverage • 11 Old Aged Homes (6 PNHs and 5 C&AHs) under CGAT coverage • 1692 residential places • Inclusion criteria: - Patients of the 11 OAHs - Medical referral required

17. Present Progress (April, 2005 to March, 2006) • Manpower: 0.2 speech therapist FTE • Total new attendance: 160 • Total attendance: 558 • No. of residents who had completed swallowing intervention by ST in April, 2005 to March, 2006 = 137

18. Outcomes • Education 2 major education programs 2002 2005 Train-the-trainer Dysphagia Management Enhancement Program Swallowing Management Refresher Course

19. Outcomes Education - satisfactory results from post-talk questionnaire survey - increase the level of awareness, risk identification and swallowing management skills • "現時的nursing home, 極需要這種訓練給予員工,讓員工 對吞嚥困難之長者護理有深刻認識;但各員工因無時間 往上課.現在有此機會,極為珍惜." • "現時一課內容很實際與本院內之長者之需求協助有密 切關係,直接幫助到現時部份老人家之需. " • "經過29-5-2001這一課,實在得益很多,有錄影帶播出,對 課程內容更加深入理解,下次講座也希望會帶帶播影. "

20. Swallowing Outcomes

21. Swallowing Outcomes – Change in diet to sustain oral feedingApril, 2005 to March, 2006

22. Escort hours and NEATS cost saved in 2001 (pilot project—1/2 year)

23. Cost of CST • (W.Y. Leung, 2004) Cost per patient treated: Cost of CST service < Cost in OPD, ST ($556.2) ($893.5)

24. Service Evaluation

25. Service Evaluation Any Policy to enhance the swallowing compliance?

26. Thank You!