Short Term Therapy Needs for Long Term Residents: Self-Feeding Needs – Jason M., OT

Working in a Skilled Nursing Facility (SNF) with both short-term rehabilitation residents and long-term care residents, I have learned that it is especially important to not overlook the therapeutic needs that the residents living in the facility may have, which are often over-shadowed by the acute, fast-track therapy programs that provided to the short-term patients. Despite how long they have resided at the facility, there is typically always something that they could improve on or be more independent with after the time and attention of a therapist. Not to mention, from a program development and business stand point, building and maintaining a caseload with long-term residents is a productive and financial must.

A quality of care indicator and a regular area of focus for long-term care facilities is a resident’s weight. In respect, a therapy consideration is their regular i9ntake and performance with self-feeding. Like many other ADL’s, a person’s ability to successfully and effectively feed themselves can change and diminish with time. This can require their plans of care to change to include increased supervision and assistance with meal times, and possibly altered diets. These changes are often reactionary from nursing and the facility for fear of the patient losing weight. These changes, however, can illustrate a need for skilled therapy services, particularly OT and ST services to assess and address the patient’s performance and needs with self-feeding.

Identifying Self-Feeding Needs:

As stated above a hallmark sign that a patient’s performance with self-feeding should be assessed is a decrease in general, consistent intake with their food and liquids with meals. Other common signs are more spilled and dropped food during a meal, neglect of certain dishes or portions of a tray, or a resistance to assistance or certain consistencies with meals. Completing a screen while observing a patient from near or across the room during a meal time is usually sufficient to merit an evaluation to further investigate what particular factors are cause a decline in their performance. Be sure to consider the visual, perceptual, and cognitive components of self-feeding in addition to the physical abilities required to self-feed. If you are going to setup a specific program and ensure safe, proper carry-over with lasting effects, the patient needs to be able to comprehend the new program or at least consistently perform with training.

Treatment Considerations for Self-Feeding Needs:

The end goal of the therapy plan of care should be to increase the patient’s overall intake with meals to an appropriate level. The patient’s nutritional needs come first. Once those are able to be met, decreasing their need for assistance and their proficiency with feeding themselves is important. The more independent and cleanly the patient can feed themselves, the more dignifying and pleasurable the activity becomes. Consider these points for treatment and trials:

• Address the performance components that are involved in self-feeding such as upper extremity joint range of motion, grip strength, dexterity, and neck mobility. If limited range of motion or the lack of strength to hold onto a spoon is all that gets in a patient’s way, simple stretching, exercises, or adaption can result in immediate improvements.
• Repetition, repetition, repetition. Self-feeding is generally an automatic human behavior and response to our need to feed. That being said, if you are going to teach the patient a new adaptive technique or reinforce their performance with self-feeding, stimulating a similar automatic response will improve their long-term performance.
• Posture and positioning while eating. With the geriatric population, kyphotic and other abnormal postures put patients in many sitting positions that limit their performance when eating. Changing the table, chair, or general postural position of the patient when eating to create a situation where their eyes and mouth are on even planes with the horizon and their food is position lower then chest height will help tremendously. You can’t eat what you can’t see.
• Trial and error with adaptations. There are many adaptive self-feeding techniques and equipment available. Trial use of different utensils, plates, tray configurations, and techniques with proper supervision and cuing. Not everything will work, but with sufficient documentation and creativity, an individualized solution for the patient’s specific needs can make the difference between independent feeding and total assistance.

Goals and Outcomes for Self-Feeding Needs:

Once the treatment course has reached a point that nursing or the patient themselves can manage their self-feeding needs consistently and at the highest level of independence, consider discharge. Understand that a marked increase in independence is not always achievable, but a through therapy course with documented trials and assessments can provide a great source of support to nursing and the facility for the need of an altered diet. Moreover, ensure the patient is getting sufficient nutrition does outweigh their need for independence. It is best practice to complete a follow-up screen and communicate with nursing and caregivers over the next few weeks to ensure the patient is maintaining their discharged level of performance. If successful:

• The patient has increased their intake; improving their overall health.
• The caregivers do not need to assist the patient as often; decreasing their overall work load and increasing their availability for other care needs.
• The patient regains some dignity; able to complete the task of feeding themselves for effectively and independently.
• Most importantly, the patient’s quality of life improves.

Long-term benefits from short-term therapy to long-term residents.