"Hello. I've been running my tail off today. I wasn't sure I had gas in the tank to be here with you....and now your meal is an hour late, so your frustration tolerance may be even more frayed than mine! No matter, I'm your man now. It's time to eat; may I help you?"
May I help you eat your meal? I see you've got (meal items). I'm going to just take a few seconds and (prepare) your plate. There; now it's time to start. I hope you're hungry! (There is your utensil) (Let me scoop up a bite for you)....what do you think?
"Hmmmmmmmmmm....I am watching you for a bit; do you feed yourself or not? It makes a difference for how well you swallow, but - no matter. Eating is not just a survival act and a cognitive act. It's a social act, too! Let's get to know each other a bit as you eat. Whatever I can teach you to do, I will also teach the staff who work with you. Ready? (holding up the utensil, stationary, so you can see it and open your mouth - before I bring it to your mouth). You see how I place the bite of food inside, so you have to make an effort to pull it off the utensil and start swallowing?? I like how people swallow more easily, when food is not just dropped at the front of the tongue. Now, here's another bite...."
I am going to help you eat; is that OK? (about 3 seconds for person served to respond 'yes') Good, thank you. (Utensil lifted, a bite of food cut from portion served into bite-size pieces). Ready? (utensil avoids 'clacking' teeth or scraping cheek, so the bite rests on the Middle/posterior tongue). I watch you swallow, before presenting the next bite....
"WHAT? WHAT DID YOU SAY? It's the staff; she said that I was feeding you too slowly, and you were criticizing how I fed you with your eyes. First of all, if they were doing a thorh job about feeding you, they wouldn't have had to refer you for a speech-language pathology evaluation. If all I were doing was feeding you, second of all, - I might do no more than drop the spoonful inside your lips. I do want to give you assistance that make your more readily swallow, as well as swallow safely. We'll get up to your speed soon enough."
I like how you looked at me intently. Don't worry; I'm not stopping your meal. I wanted to see how well you were paying attention, and - YOU ARE. Here's another bite; ready? Good, I'm glad you are enjoying that....A cough? Yes, cough it out well. A strong cough is an important skill to have. Good then; can we keep going? OK, here's another bite; another sip. Oops! That mess is my fault. Good, and another - another - you're doing quite well today.
"I do want to do a number of these observations of your eating and drinking. A sufficient sample size of them, and each of them being not cross-sectional but longitudinal. I want to see you consistently eat and drink, while using these skills and strategies we have tried today. What do you think? I don't want to change your diet unless absolutely necessary. Can we do this?"
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