"Falls in the Nursing Home: The Role of the Speech Language Pathologist (SLP)"

Learner Objectives
1.  Learner will gain familiarity with some possible strategies and techniques that an SLP
     may provide to patient when addressing specific areas.
2.  Learner will be able to state 3 possible areas that an SLP may encompass in his/her
     treatment plan.
3.  Learner will gain information regarding the role of an SLP when assisting with reduction
​     of patient falls in the nursing home.
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Attention and Concentration
  Increasing maximal attention
*Goal:  To maintain attention to structured tasks with less than 2 redirections.
*Activities:  Making a grocery list, following map directions, sequencing tasks
*Possible Strategies/Techniques:  Maintaining eye contact, speaking slowly, repeating information as needed, turn off the radio or television, closing the door during therapy to decrease distractions and background noise, complete only one task at a time.
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Memory
  Addressing short term and long term memory
*Goal:  To increase recall of daily events and therapy details with minimum cues.
*Activities:  Listening to a list of directions, presenting patient with pictures of different people and then have he/she recall the names of each person.
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Safety Awareness and Reasoning
  Due to cognitive deficits and lack of insight, patients may be at an increased risk for future falls.
*Goal:  To increase safety awareness/problem solving skills to a maximal level for re-entry into the community.
*Possible Recommendations: Patient may need a room closer to the nurse's station so that they can be closely monitored, written reminders (i.e. "Do not get up unassisted!") reviewed and posted in room.
*Activities:  Reviewing and reinforcing safety precautions (i.e. ringing red call button and waiting for assistance, locking wheelchair before standing), safety cards, written steps to carryout a task (e.g. transferring from bed to wheelchair).
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Orientation Skills
  Sometimes after a patient has a fall he/she may lack awareness of the time, place, existing situation, and identity  
  of people.
*Goal:  To orient patient x 4
*Activities:  Family can bring in pictures of family members and pets as visual reminders of familiar people and different areas in their life, using the calendar to orient to time, checking daily to see if patient is oriented to person, place, situation and time (re-orient as needed).
*Strategies/Techniques:  List of medications, visitor log, memory book or day planner which includes:  calendar, daily schedule, names and roles of therapists, doctors and nurses
Many of these strategies are great to help improve patient's short term and long term memory as well as orientation skills.
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Counseling
*One of the patient's that I worked with when I was doing my internship in the nursing home told me once, "Part of growing old is letting go of the things you love."  I have never forgotten that quote till this day, which brings us to the next important area, counseling.
*Most adults that are seen on a daily basis for therapy have suffered traumatic events that have caused many changes in more than one area of their life.  So as a speech language pathologist it is important to keep that in mind when working with this population.  Some are having to adjust to a change in schedule, asking for help and waiting for help with a skill that they have been use to doing independently, and many other changes that they experience. 
*ASHA's "Scope of Practice" states that we as SLPs can/should provide counseling for those individuals we see for therapy with communication/swallowing disorders. 
*It is important to help the patient realize that "they are still the same person, but just with different pieces."  
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Resources
American Speech-Language-Hearing Association. (2007). Scope of Practice in Speech-Language Pathology [Scope of
   Practice]. Available from www.asha.org/policy.
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*The information above was from a PowerPoint for an Inservice project for my internship in a Skilled Nursing Facility (SNF).  I hope you all enjoyed it, let me know what you think the role of the Speech Language Pathologist when pertaining to falls in the nursing home.