By Tamala Sammons, MA CCC-SLP, Senior Therapy Resource

Contributed from the American Speech and Hearing Association (ASHA.org)  https://www.asha.org/practice/reimbursement/medicare/medicare-patient-driven-payment-model/#Fall

SLPs can help increase the rate of discharge back to the community and decrease avoidable rehospitalizations. Specifically, SLPs can positively influence the following factors that contribute to discharge back into the community:

Communication: A primary purpose for addressing communication and related disorders is to affect positive measurable and functional change(s) in a person’s communication status so that they may participate in all aspects of life — social, educational and vocational.

Communication is central to discharge back into the community, especially in individuals with speech/language impairments or cognitive deficits associated with a variety of diagnoses. Several studies have indicated that communicative competence predicts individuals’ safe discharge back to the community.

  • For example, a 2013 study found that deficits in auditory and reading comprehension and oral spelling to dictation were significantly associated with increased odds of discharge to a health care facility (e.g., SNF), rather than to a community-based environment, after adjustment for physical therapy and occupational therapy recommendations (González-Fernández, et al., 2013).
  • Functional dependence and comorbidities, such as chronic aphasia, have been found to be a significant predictor of a non-home-based discharge setting in post-stroke individuals (Mees, et al., 2016).

The SLP’s scope of practice and unique training specifically equips them to prepare individuals to return home with appropriate communication facilitators, as needed, ensuring maximum safety.

Cognition: Cognition is an important predictor of safety and functional independence in determining discharge to home, even in individuals undergoing purely orthopedic-related rehabilitation (Ruchinskas, et al., 2000).

Several studies emphasize the importance of cognition in the ability to return to completely independent living after medical rehabilitation in geriatric patients (MacNeill, et al., 1997). The Scope of Practice in Speech-Language Pathology (ASHA, 2016), as it relates to cognitive-communication impairments, indicates that the practice of speech-language pathology includes providing prevention, screening, consultation, assessment and diagnosis, treatment, intervention, management, counseling, and follow-up for disorders of cognitive aspects of communication (e.g., attention, memory, problem solving, executive functions).

Swallowing: SLPs with appropriate training and competence diagnose and manage oral and pharyngeal dysphagia. SLPs also recognize causes, signs and symptoms of esophageal dysphagia and make appropriate referrals for diagnosis and management. Presence of dysphagia represents a significant barrier to returning home, specifically in neurogenic diagnoses. Those individuals with dysphagia, post-stroke, are more likely to be discharged to institutional settings, such as SNFs, after inpatient stroke rehabilitation, and experience longer stays at these facilities (Nguyen, et al., 2015). Aside from the significant costs resulting from chronic dysphagia and associated care, these conditions have a negative impact on an individual’s quality of life.

Health Literacy: More than just a measurement of reading skills, health literacy also includes writing, listening, speaking, arithmetic and conceptual knowledge.

According to the IOM report (2004), health literacy is “the degree to which individuals have the capacity to obtain, process and understand basic information and services needed to make appropriate decisions regarding their health.” Inadequate health care literacy affects all population segments but is predictably more common in certain demographic groups such as the elderly.

Patients with aphasia or other neurological disorders affecting speech, language or cognition, or those with severe hearing loss, are at risk when presented with vitally important written or verbal medical information. In addition, patients who face the stress of a medical crisis, possibly without an advocate or a significant other being present, or while in a state of pain, confusion or depression, may have difficulty understanding written or verbal medical information.

SLPs have a vital role in effective patient-provider communication. As federal laws, regulations, guidelines and accreditation standards mandate improved patient provider communication, it is vital to maximize the SLP’s contributions to this significant area of practice that impacts patients’ safe discharge back to the community. The rate of hospitalization and use of emergency services is higher among patients with limited health literacy (Kindig, et al., 2004). SLPs can assist with discharge planning while considering an individual’s health literacy to minimize these costs (Rasu, et al., 2015).