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I Speak Fine – Speech Therapy and its role in Assisted Living

by Danielle Bates CCC-SLP | FOX Rehabilitation 

During the month of May we celebrate National Speech – Language – Hearing Month to provide awareness about communication disorders and to recognize those who work to support people who struggle with them. One of those specialists is a Speech Language Pathologist who practices speech therapy.

Northbridge has a partnership with FOX Rehabilitation that allows our residents to take advantage of a multitude of therapies once they move into a Northbridge community, from the comfort of their community. These include physical therapy, occupational therapy (check out our blog), and Speech Therapy. To learn more about what speech therapy is and what a Speech Language Pathologist does, we’ve invited FOX Rehabilitaion Speech Language Pathologist, Danielle Bates to write a guest blog about her work as a Speech Therapist in Assisted Living. Danielle works with the Northbridge communities, Stroudwater Lodge and Avita of Stroudwater.

Danielle is a Speech Language Pathologist with Fox Rehabilitation and graduated with her undergraduate degree in communication sciences and disorders in 2014 and then her graduate degree in communication sciences and disorders in 2016, both from the University of Maine. She is licensed as a Speech Pathologist and is able to work with patients throughout the lifespan. In her blog, Danielle shares what speech therapy is, what she enjoys about working with seniors and what to look for that might mean it’s time to see a speech therapist.

I speak fine, why do I need speech therapy?

When I meet with a new or potential patient for the first time, I’m often greeted with lines like – I speak fine, I don’t need speech therapy. What I wish people realized about my job is, it’s so much more than the motor function of speech. Speech Language Pathologists are licensed to work with patients throughout the whole lifespan. Starting with babies in the neonatal care unit with feeding, supporting moms with lactation, and babies and children with cranial facial abnormalities such as a clef lip or clef pallet. As kids age the challenges change and we might focus on articulation, swallowing, and sensory motor. Moving into adolescence and early adulthood it could be working with children on the spectrum to assist with nonverbal ques, and social, emotional support or help with communication skills. This continues into adulthood with things like strokes and as you get into the more geriatric population it merges into preserving communication or the rehab portion of communication – feeding, swallowing and your voice.

While in school, I was able to work with a variety of populations from elementary school where the focus was on social emotional communication, to the hospital where it was more acute care, and my last rotation was in a skilled nursing long term care facility which is when it clicked for me that I enjoyed working with the senior population. Working with someone who has dementia means that every day is different and you’re always problem solving. What works one day might not work the next, and the rapport you build is slow but once you gain trust, it’s so gratifying.

Why is Speech Therapy important in Senior Living and what does it look like?

When I’m first meeting with a resident at a Northbridge community, they’re either moving from home or from a skilled rehab and aren’t able to move back home. Maybe something happened, a fall, stroke or heart attack and it’s not safe for them to live by themselves anymore. They are coming to the community after a change in status. What I do, and this is something that FOX Rehabilitation does well, is get a good baseline and look at everything under my scope of practice.

Here is what I typically look at:

• Language – receptive and expressive language
  •  Receptive Language – the way that you receive language, more than just hearing it but attending to it, understanding it and synthesizing it.
  • Expressive Language – the ability to formulate words and have the communication come outwards. It’s different then speech, speech is a motor component. Expressive language is taking what’s in your brain, thoughts, and feelings, and getting them out of your mouth.
• Voice – can they communicate, is their volume appropriate, are they going to be able to be understood in that big, loud dining room?
• Getting to meals – do they know where the dining room is? Are they making it to the dining room and participating in meals?
• Dining – Are they able to read the menu, are they able to make selections from a written menu or do they need the options read aloud to them?
• Eating – when they’re eating are they taking a few bites and pushing it away, is it not what they’re liking, is there a weight loss risk, are they spitting their food out because at home they weren’t eating well and they’ve lost weight and now their dentures don’t fit properly?
• Dentures – if there dentures aren’t fitting correctly what are the solutions – do we need to get denture adhesive or do we need to work with the nurses to get a referral to a periodontist?

Doing this assessment gives a really good time stamp of where a resident is at when they first move into the community. It’s great to look back after 6 months or 1 year to see if we’ve noticed a shift.

What are some signs that it might be time for Speech Therapy?

1. If you find your loved one’s communication has shifted and they aren’t initiating conversation. For example, your dad used to call you and talk your ear off, or mom and you would go back and forth while cooking and you’re starting to see them withdraw.
2. If you notice a weight loss or your loved one used to enjoy going out to eat or always finished their meals and all of the sudden their appetite is no longer or nothing seems good to them.
3. If their voice becomes quiet- you start having trouble hearing them on the phone.

How long is a typical Speech Therapy session?

The length of a session depends on what the goals of care are, typically no longer then 90 days and usually around 6 weeks. If something happens, we can always go back and revisit. During the session I typically meet with a patient two or three times a week. There are more intensive programs, for example the Speak Out Parkinson’s program. Speak Out is a 4-week program where I meet with the resident 4 times a week.

Speak Out is a great program specific for Parkinson’s patients and we’ve seen some great results from it. A lot of the program focuses on sustained vowel phonation, like saying AHHH and working within a high decibel range. The thing with Parkinson’s is it’s not an atrophy of the muscles, it’s not like ALS, it’s like they’re walking through molasses so what takes most people a 2 out of 5 effort for someone with Parkinson’s is a 5 out of 5 effort. The program gets them used to an elevated level of effort to get them closer to where they were pre-Parkinson’s. We work on sustained vowel phonation, language, reading for increasing levels of difficulty – starting at the word level and moving to sentence level and reading an entire paragraph loudly. Also tying in the cognitive piece with finishing a phrase or sentence, bread and ______, water and _______, cream and ________ but they need to be just as loud with the word that they’re filling in as they are at the beginning. We want this to eventually carry over to be part of spontaneous speech.

What does a typical Speech Therapy session look like in Assisted Living?

After the initial assessment we might notice that someone is having trouble chewing and swallowing, taking us down the path that maybe their dentures aren’t working well. The first thing that would happen is I would see them for a meal, we can eat in their room or in the dining room. I’ll sit with them and work on compensatory strategies so I’m reminding them to cut their food up small so it’s easier to chew. I’m reminding them that after they take a bite, chew, and swallow they need to take a drink. In that session we might also work on communication, I’m looking at if they are able to order appropriately with their server, were they able to get to the dining room on their own to meet me there, or did I have to go find them. After the meal with them, we might spend some time back in their apartment for something more formal focusing on comprehension.

Some of these exercises I do include:

• Giving them so many minutes to name as many things that start with a specific letter.
• Taking 4 words and having them tell me what category they all belong to or pointing out any outliers.
• More functional examples are- naming things within their apartment or within their assisted living community.

Assisted Living can bring about cognitive linguistic challenges and opportunities, especially in the beginning. As soon as someone wakes up, they might be conversing with care staff, making decisions, orienting to the dining room, having conversations with their peers, going to exercise class. All these things are taxing different sections of your brain and that’s something that I can’t replicate, I find it better when you’re immersed and your brain is busy.

Residents move from home, where they might not have talked to anyone or just one other person, to a community where they might be talking with a variety of people, peers, and associates throughout the whole day. Whether they realize it or not, I think residents crave that conversation. COVID was so isolating, especially for seniors, so I find that most people welcome the stimulation. At a minimum they love going to the dining room and chatting in an informal manner.

There’s the saying – “if you don’t use it, you lose it” this is true of social emotional skills. The push and pull of a conversation, the natural flow and being able to reorient yourself to where the conversation is going and flowing along. The ability to hold a conversation is a skill that if not used, can be lost. You also learn new things as you talk to new people, you’re opening a whole new dialogue vs. the ones you’ve had for years. You could have spent most of the last few years only conversing with your kids or your spouse who have known you forever and could probably finish your sentences. When you first move into a community, you are re-introducing yourself and that’s such a unique opportunity.

What do you wish people knew about Speech Therapy?

Don’t be nervous to meet with me or equate it to something you experienced in school, see it as an opportunity to work on your communication.

The ability to make our wants and needs known as we age is so important. To hold onto our ability to communicate with our loved ones and peers should be prioritized the same way we prioritize our legs working well or the ability to shower and bath independently.

Communication is a skill that takes practice and work, especially as we get older, but it’s something that you want to and can hold onto.

Residents at Northbridge enjoy these services in the comfort of their community. This means that instead of going out for speech, occupational and/or physical therapy multiple times a week, it can be a small part of your weekly schedule. This allows residents to continue to enjoy the variety of programs that take place within the community. Residents benefit from the services that FOX Rehabilitation provides but also maintain the social calendar that they enjoy. One of my favorite parts about my job is when I start working with a resident and they’re new to the community and hesitant to join in on the community programs and hesitant to work with me. Slowly we develop a rapport and in addition to becoming comfortable working with me, I see them joining in on community programs. Someone who initially moved here because of the wishes of his daughter, is now a regular at exercise class and always going out on trips. Walking by the dining room I see them sitting at a table full of friends and enjoying the socialization.

I also enjoy being part of the transition when a resident first moves into the community. It can be a tough transition for the resident and family, there is a lot of guilt for the family member and hesitation for the resident. I really enjoy coming in and working with residents and seeing them thrive. It’s helpful for families because they start to see that instead of taking something away from them when moving in, they see it as something they were able to give their loved one.

Danielle works at Northbridge communities, Stroudwater Lodge and Avita of Stroudwater meeting with residents to provide Speech Therapy services.

To learn more about FOX Rehabilitation be sure to check out their website – foxrehab.org.

To learn more about the partnership a Northbridge Community near you has with FOX Rehabilitation, click here to find a Northbridge community near you and connect with one of our helpful Sales Directors!

We’re here to answer any of your questions, please contact us if we can provide further information or if you would like to schedule a personalized tour.