Where There Is No SLP - Language Strategies (fourth in a series)

What can you do, if your home health patient doesn't have speech therapy - but isn't communicating well with language? Problems with language skills can make a patient less competent to meet needs, share information, maintain social closesness, and observe the conversation rules of her/his community. Whether the patient is challenged for understanding and/or using language, preventing long - term effects of challenges to a patient's language status is a worthy goal of home health intervention. Where there is no SLP, what can you do help the patient to function best to meet her/his language needs?

As in the case with persons having problems hearing or with cognition, knowing the patient's hearing status will be helpful. If a patient shows you that understanding your directions requires a lot of effort, you can help by using simple language that you share by speaking clearly. Demonstrate any actions that you want the patient to initiate, by gesture and repetition. Be a patient listener to understand the patient's message. If the patient uses a communication system that depends upon skills other than oral language, confirm that you understood the patient's message.

Where There Is No SLP - Speech Strategies (Fifth in a Series)

What can you do, if your home health patient doesn't have speech therapy - but isn't using functional speech? Problems with speech skills can make a patient less effective for meeting needs, sharing information, maintaining social closesness, and observing the conversation rules of her/his community. Whether the patient is challenged for using speech communication, preventing long - term effects of challenges to a patient's speech status is a worthy goal of home health intervention. Where there is no SLP, what can you do help the patient to function best to meet her/his language needs?

Some of the strategies that are used for a patient with hearing loss or cognitive impairment, will also be helpful in working with a person having speech difficulties. Maintain eye contact; minimize background noise; keep the style of conversation simple; confirm what you have heard from the patient. Technology has made participation in daily living easier than ever for speech impaired persons. You can write, text, spell out a message on a low - tech communication board, or compose a 10 - minute speech that can be spoken electronically. Advocate for your patient as you can - not only with the family and caregivers, but also in the patient's community.

Where There Is No SLP - Cognition Strategies (third in a series)

What can you do, if your home health patient doesn't have speech therapy - but isn't thinking well? Problems with thinking (cognition) skills can make a patient less independent, and even jeopardize her/his safety. Human cognition is a complex hierarchy of skills that we depend upon for living in the modern complex world. Preventing long - term effects of challenges to a patient's cognitive status is a worthy goal of home health intervention. Where there is no SLP, what can you do help the patient to function best to meet her/his cognitive needs? Remember that hearing impairment in adults is a major risk factor for development of cognitive impairment. Suggest the patient get a hearing screening, either through self - assessment or behavioral testing.

Effective communication with your patient during the visit will make thinking through your activities easier. For example, speak clearly with the patient, maintaining consistent eye contact. Regularly ask the patient to "teach back" what you have demonstrated or explained. Use the "WRAP" strategy (write down; repeat/routine; associations; picturing) to help the patient retain your information. Supply WRITTEN illustrations of home exercises when possible. If the patient does not easily initiate an action (e.g., picking up a utensil or taking a step), give a timing cue by modeling what you wish her/him to do.

Where There Is No SLP - Swallowing Strategies (second in a series)

What can you do, if your home health patient doesn't have speech therapy - but doesn't swallow well? Swallowing breakdown not only can challenge a patient's respiratory system, but also can be a serious barrier to general health. Swallowing problems (dysphagia) are such a high - risk problem, that they are often the first reason doctors refer their patients to SLP. Preventing long - term effects of challenges to a patient's nutrition/hydration is a worthy goal of home health intervention.

Where there is no SLP, you can still have a positive effect on the patient's oral health and hydration status. How does the patient maintain oral care? The mouth can be a portal to many bad things. Encourage the best possible oral care.

Dehydration is easily achieved, but sometimes not easily corrected. The clinical signs of dehydration you can easily see. Even sharing an ounce of water with the patient during a therapy visit can be a reminder: SIP VOLUMES OF BEVERAGES EACH MORNING TIL NIGHT.

Where There Is No SLP - Hearing Strategies (first in a series)

What can you do, if your home health patient doesn't have speech therapy - but doesn't hear well? Hearing loss is one of the strongest risk factors for cognitive impairment in older persons. Preventing long - term effects of challenges to a patient's hearing is a worthy goal of home health intervention.

Where there is no SLP referral, try to observe the following. Does the patient complain of changes in how the ear feels? Those signs may require a medical referral. Can your patient understand louder sounds best? Does she/he confuse words in conversation? Use strategies that help the patient understand your directions and your teaching. Strategies may include: constant eye contact when speaking; slower speech rate; stressing key words; gesturing; or writing down what you said.

To document the patient's perception of her/his hearing, complete: REVISED HEARING HANDICAP INVENTORY - SCREENING VERSION. THe patient can use the experience of communicating with use of strategies, as well as the self-perception of hearing function, to decide about possible hearing rehabilitation.