How does speech therapy fit into end-of-life care? - Patient Handout

Speech therapists are usually associated with helping children learn to speak or helping adults regain their speech after a stroke. But speech therapists can help people who are nearing the end of their life as well. They don't just help people speak clearly, but also assist with eating, drinking, and even making important choices.

End-of-life care, palliative care, and hospice care all focus on a person’s comfort and well-being when they have a serious illness. End-of-life care means any care given to someone nearing the end of their life. This could include palliative care or hospice care. Palliative care focuses on managing pain and symptoms while still trying to treat the underlying condition while hospice care is for people in the final states of a terminal illness.

Let's find out how speech therapy becomes a helpful part of end-of-life care.

What is palliative care?

 Palliative care starts when the focus of medical care changes from curing the illness or disease to making you feel your best even if regular medicine might not be enough to make you feel all the way better.

Palliative care teams focus on pain relief, symptom control, and emotional support. It’s about making sure you are comfortable and getting the support you need during a hard time.

For example, palliative care is going to radiation for cancer treatment but instead of trying to get rid of the cancer completely, it focuses on making you as comfortable as possible while you’re going through radiation treatment.

What is hospice care?

Hospice care is a type of care for people who are nearing the end of their life. Hospice care focuses on making people comfortable and helping them live in peace and dignity.

Hospice care teams focus on pain relief, emotional support, quality of life and potentially having the person transition back home or stay at home.  Hospice care is not about curing the illness. It’s about making the most of the time a person has left at the end of their life[MG2] .

Palliative care and hospice care both focus on comfort and improving quality of life for those with serious illnesses. However, palliative care can be provided alongside medical treatments designed to cure the illness or disease. While hospice care is for patients with a life expectancy of less than 6 months who have chosen to focus on comfort rather than curing the illness or disease.

How does speech therapy fit into the medical model of end-of-life care?

Both hospice and palliative care play an important role in the final stages of a person’s life. Both types of care promote dignity, peace, and comfort either in a facility or at home. Maintaining quality of life and keeping the family involved in end-of-life care is important.

Typically, people in hospice or palliative care wish to remain as independent as possible for as long as possible.

Speech therapists, traditionally, work on the rehabilitation of patients. For example, if a patient has a stroke, and can no longer safely swallow food or talk, a speech therapist helps that person talk and swallow again.

In end-of-life care, the goal is to limit the impact of advancing disease and help people continue to eat safely and communicate easily with their families and caregivers.

When to call a speech therapist?

Involve a speech therapist when you start to worry about your loved one’s swallowing and/or communication abilities.

As we age and especially towards the end of our lives, our ability to eat and drink safely can decrease. A swallow evaluation by a speech therapist can help patients avoid adding a life-threatening illness like pneumonia to their current health problems.

Family members want to continue to be able to communicate with their loved ones until the end. Especially, if they have questions about what the person may want on care and end-of-life arrangements. If you are struggling to communicate with your loved one contact a speech therapist.

What will the speech therapist do during the evaluation?

Once a doctor refers a speech therapist to the person they will start by evaluating the patient’s swallowing, and communication abilities. They will talk to nursing staff, and review medical records before the evaluation.

You can expect that during the evaluation the speech therapist will have the patient eat and drink different types of food textures and liquids.

This can include putting the patient on a diet that is safer for the patient. This will reduce the patients risk of choking or having food go into their lungs. The speech therapist may recommend a softer food diet or food chopped into bite-sized pieces.  

Speech therapists can also recommend safe swallowing strategies based on the evaluation results. These could include the patient taking small bites and sips, coughing after drinking, and alternating liquids/solids during meals.

For the speech and language part of the evaluation, the speech therapist will talk with the patient and interview the family/caregivers to determine the level of support and training needed.

How can a speech therapist help my loved one?

Speech therapists can support people at the end of their lives. They can:

·      write a report on the patient’s communication strengths and preferences

·      train caregivers and family members on swallowing and communication strategies

·      use communication supports like pictures of spiritual importance or photos that show medical decisions

·      provide a voice amplifier or assisted listening device

·      recommend a specific food texture or liquid texture

Speech therapists can help families handle difficult end-of-life conversations because they are experts in swallowing. Near the end-of-life, people often refuse or express little interest in eating. Families often need extra support to handle this change and an expert in swallowing like a speech therapist can help families understand what is happening with their loved one.

Speech therapists can powerfully impact people’s end-of-life care satisfaction concerning swallowing and communication. Both are important pieces of life satisfaction. A speech therapist will likely only need to address swallowing and communication for a short time but the results can be eye-opening.

Call a local speech therapist in your area or talk to your nursing director at your hospice care organization today to receive speech therapy services for your loved one.