Speech Therapy

The Role of Speech Therapy in Hospice Care

When we help a home hospice patient, the family becomes accustomed to receiving our many different health specialists. Physical therapists, nurses, and social workers are expected guests, but some people are surprised if our doctor recommends that their terminally ill loved one be evaluated by a speech therapist. Many people think speech therapy is dedicated solely to helping children with stutters and other vocal problems, but it has a valuable role in hospice care, too.

The duties of a speech therapist are broadly divided into two parts:

1. They help patients communicate.
2. They help patients who struggle to swallow.

Communication is a critical component of a patient’s quality of life. Being able to communicate lets the patient participate in decision-making and socialize with her family and her caregivers.

But the second aspect of the therapist’s role is not so obvious. Speech therapists, being knowledgeable about all things related to the mouth, tongue, and throat, can help patients who are struggling to swallow. This is a vital part of a patient’s satisfaction and comfort, so issues with swallowing must be assessed.

UCLAH’s speech therapists are a critical part of the home hospice care team, and their services help patients live their final months in comfort.

The Role of Speech Therapy in Hospice Care

Aiding in Communication

For terminally ill people, loss of speech can happen for many reasons. Cancers and other illnesses can diminish the capabilities of a patient’s voice. Certain surgeries can alter the throat. Dementia and other neurological problems can affect the patient’s ability to speak.

Our therapists are familiar with the many disorders and problems that might affect the voices of terminally ill patients. As much as possible, our therapists will help the patient retain the ability to speak. We believe that using one’s own voice to communicate is best, even if it requires some effort.

There are times, however, when speaking becomes impossible despite the best efforts of the therapists and the other caregivers. For these times, our speech therapist will help the patient learn an alternative form of communication that will allow the patient to express her wants and needs effectively.

There are a variety of alternative communications that might be employed.

- Low-tech options include using gestures and facial expressions to communicate needs.
- A grid with pictures or words at which the patient can point is a common, easily understandable method of communication.
- With the help of an occupational therapist, some terminally ill patients can communicate their needs through writing or drawing.
- High-tech options, such as certain tablet apps, or specialized speech-generating devices, are also effective in helping seriously ill people communicate.

Every patient is different; some have perfectly healthy voice-producing organs but suffer from dementia, making intelligible speech impossible; others may be able to produce no sound at all because of their illness but are still mentally sharp and dexterous enough to use a technology-based solution.

Our speech therapist will discuss with family members and the other professionals what options will work best for the ill patient. Once a plan is set, the therapist will teach the patient to communicate in the best possible way. We will make sure that all family caregivers and home health aides understand how the communication solution works, so there’s no risk of the patient being unable to make herself understood.

Aiding in Swallowing

For a patient in hospice care, being unable to swallow has a grievous impact on the quality of her life. Pills and liquid medicines cannot be swallowed and must be delivered through more painful and invasive means, such as intravenous and intramuscular injections. Being unable to eat or drink will accelerate the patient’s decline from lack of nutrients and hydration, and an inability to enjoy food can seep the very joy out of her life.

It is possible to deliver nutrition and hydration through intravenous therapy, but this comes with a host of unpleasant side effects: pain and the risk of infection at the insertion site, bulky IV tubing and apparatus reducing freedom of motion, and complications from the injected substances themselves, such as liver and kidney problems and fluid overload. Any extension of life granted by IV therapies must be balanced carefully with the negative impact they will have on the patient’s quality of life.

Even if there were no side effects, IV nutrition and hydration are no replacement for eating and drinking. Think of the simple pleasure you get by eating a favorite meal, drinking a glass of cold water on a hot day, and sharing a convivial meal with loved ones. Hospice patients can feel the loss of those joys keenly, so it is UCLAH’s intention to help patients retain the ability to swallow as much as possible. Speech therapy to aid in swallowing, combined with occupational therapy to help with grasping cups and utensils, can greatly improve a patient’s quality of life.

Swallowing difficulties have many causes: strokes, brain injuries, Parkinson’s disease, multiple sclerosis, head and neck injuries, and cancers of the throat are just a few examples. Each might affect swallowing in different ways, so our therapists are well versed in many methods of aiding swallowing.

- Simple exercises can limber the muscles used for chewing and swallowing.
- Some medicines cause dry throat, which can inhibit swallowing; in that case, the speech therapist might ask the doctor to prescribe a different medication.
- Family members can assist the patient with exercises and prepare food and drink that are easier to swallow.

UCLAH’s Speech Therapists

In both roles—aiding in speaking and in swallowing—our speech therapists are highly trained and necessary parts of the hospice care team. The goal of hospice care is to maximize the comfort and quality of life for the terminally ill, and being unable to communicate or swallow can make life difficult, even intolerable. We at UCLAH believe that most hospice patients can benefit enormously from the attention of one of our professional, compassionate speech therapists.