Supporting graduate speech pathologists working in aged and end-of-life care

A guest blog by Dr Laura Chahda, Senior Lecturer, Researcher and Speech Pathologist at Victoria University

Speech pathology has long been integrated into the aged care setting for provision of assessment and management of swallowing and communication disorders for the elderly population. However, aged care has historically been a largely ignored area for clinical practice, with hospital, community and private practice being more well-known avenues and preferred pathways for graduates.

The need for speech pathologists for both communication and swallowing disorders is significant; particularly when we know that nearly 95% of older people in aged care have developed a communication disorder of some form, and up to 50% may have dysphagia. Subsequently, speech pathologists are an integral part of an aged care allied health team. As a speech pathologist and senior lecturer, I often get asked the same questions about working in aged care – and this is the advice I would provide…

Is working in aged care rewarding?
Absolutely! There is no other clinical setting quite like aged care. Clinicians working in this space are often exposed to wide range of health conditions (i.e., stroke, progressive neurological disorders, cancer, respiratory disorders etc.) and at different stages. This allows the clinician the opportunity to be exposed to a wide range of swallowing and communication presentation that quickly enriches their clinical skills and broadens their knowledge across many domains. The aged care setting also opens up clinical exposure to palliative and end-of-life trajectories which requires the clinician to quickly adapt their assessment and management approaches to often at times think ‘outside the box’ to ensure that quality of life is of paramount focus. In addition, speech pathologists working in aged care also get a more realistic and ‘downstream’ insight to the interventions and recommendations that clients may have received in an acute or rehabilitative setting and have a unique perspective and appreciation in identifying which approaches or clinical interventions are feasible on a long-term or permanent basis.

Do I need any extra training?
Speech pathologists working in aged care need to be conscious that they are working with a population where health status can change rapidly or progressively deteriorate (if palliated). It will be important to confidently assess and implement an intervention plan that will not only support the client, but also be functional, value quality of life and autonomy and that can be responsive to change. It is also important that the plan is understood and accepted by all parties including the client, their family and care and nursing staff, until the next planned review – which, in the contractor model, can vary from one to often several weeks. This can be quite daunting for a new graduate speech pathologist or inexperienced clinician wanting to work in the aged care setting and it will be important to ensure you are aware of what training and support is available. The Allied Health Toolkit has several resources you can download to help facilitate team communication, and action plans for care staff in between visits. There are also links to short online courses around end-of-life communication and palliative care more generally, and links to navigating the various funding models applicable to aged care.

So, is this area of practice sometimes difficult to navigate?
Yes, it can be. The commonly utilised contractor model can result in restricted reviews and contact with clients. In addition, the home package funding model has not historically incorporated equal inclusion of speech pathology services. Instead, there has previously been a focus on limited communication domains (i.e., swallowing), meaning that many older Australian’s needs have been often unmet and underserviced [1-2]. Therefore, it’s important to make use of support networks within the speech pathology discipline (e.g., SPA Mentoring program), but also to develop relationships with the facility staff and the interprofessional health care team to advocate and promote the role of the speech pathologist in aged care.

So, if we need more speech pathologists, how can we grow capacity in aged and end-of-life care?
The answer, I believe, starts at the very beginning. More targeted speech pathology clinical placements within the aged care sector need to be considered. It is acknowledged that despite the increasing demands for speech pathology services in aged and palliative care services [3], tertiary training is not yet adequately preparing students to work in this area [4-6].

Tertiary institutions should be encouraged look to the aged care setting as an opportunity to collaborate and integrate key clinical placement opportunities and invite speech pathologists working in aged and palliative care to contribute key clinical skills and practical learnings they have learned in the industry and incorporate them in the adult speech pathology curriculum (i.e. workshops, case studies, guest lectures etc.). In turn, speech pathologists working in aged care should ideally be supported by tertiary institutions to maintain skills and knowledge in clinical education in order to feel confident and prepared to take on students in this health setting (i.e. knowledge and application of professional standards, student support approaches etc.). Further, specific focus on supporting new graduates within the aged care setting through networks such as special interest groups and/or one-on-one mentoring would assist in promoting clearer pathways to aged care.

On a more macro level, aged care facilities should see this clinical placement opportunity as a ‘value-add’ to their service, incorporating more assistance and monitoring during mealtimes, auditing the diet and fluid recommendations and associated documentation within the facility and targeting communication and cognitive needs that has historically been neglected due to the restrained funding models in aged care.

References

1. Bennett M, Cartwright J, & Young J. (2017). Is the speech-language pathology profession prepared for an ageing population? An Australian survey. International Journal of Speech-Language Pathology, 21(2), 153–162. https://doi.org/10.1080/17549507.2017.1413135

2. Folder N, Cartwright J, Torresi K, Taylor-Rubin C, Conway E, Murray J, Caruana A & Power E. (2022). Stepping back into the dementia space. Journal of Clinical Practice in Speech-Language Pathology, 24(2), 67-72

3. Chahda L, Carey LB, Mathisen BA, & Threats T. (2021). Speech-language pathologists and adult palliative care in Australia. International Journal of Speech-Language Pathology, 23(1), 57–69. https://doi.org/10.1080/17549507.2020.1730966

4. Chahda L, Dell’Oro H, Skeat J & Keage M. (2022). Learning at end of life: Preparedness of speech language pathology graduates to work in palliative care. Journal of Clinical Practice in Speech-Language Pathology, 24(2), 77-79

5. Mahendra N, & Alonso M. (2020). Knowledge of palliative care and advance directives among speech–language pathology students. Topics in Language Disorders, 40(3). https://doi.org/10.1097/TLD.0000000000000224

6. Pascoe A, Breen LJ, & Cocks N. (2018). What is needed to prepare speech pathologists to work in adult palliative care? International Journal of Language & Communication Disorders, 53(3), 542–549. https://doi.org/10.1111/1460-6984.12367

 

Dr Laura Chahda
Senior Lecturer, Researcher and Speech Pathologist at Victoria University