Management of Dysphagia in Nursing Homes During the COVID-19 Pandemic: Strategies and Experiences

Abstract

The global 2019 novel coronavirus disease (COVID-19) pandemic has had devastating effects not only on healthcare systems worldwide but also on different aspects of the care provided to nursing home residents. Dysphagia management is a crucial component of the care provided to many nursing home residents. This article presents the dysphagia management strategies applied in Hong Kong during the COVID-19 pandemic and the related experiences. A two-tier protection system was implemented wherein residents were categorised according to their contact and hospitalisation histories. The provided swallowing management and personal protective equipment level differed between the two tiers. The article also discusses the referral and prioritisation of clinical services for residents requiring swallowing management, as well as the adaptations of swallowing assessment and management during the pandemic. The possible effects of COVID-19 on mealtime arrangements in nursing homes, the implications of the pandemic on the use of personal protective equipment and the use of telepractice in nursing homes were also discussed. This article has summarised the actions taken in this regard and may serve as a reference to clinicians who are responsible for swallowing assessments and dysphagia management in nursing homes.

Telepractice and Dysphagia Management: The Era of COVID-19 and Beyond

“…Although dysphagia was recognized as a prevalent sequela of COVID-19 [ 19 ] there were suddenly disruptions and barriers to providing usual dysphagia management for both COVID and non-COVID patients across every clinical domain. These barriers were created by infection control risks, particularly those associated with clinical and instrumental assessments being classified as aerosol generating procedures [ 14 , 20 – 22 ], as well as concerns for high-risk clinical populations [ 6 ] such as those in aged care [ 23 ] and people with head and neck cancer [HNC] [ 24 , 25 ]. The situation was then further exacerbated for some by other operational challenges, such as the need to ensure staff had adequate access to necessary personal protective equipment (PPE) [ 6 , 22 ], and in Australia a barium shortage further impacted the ability to conduct videofluoroscopic assessment (VFSS) services.…”

Consensus on the Objectives of an Educational Intervention for Patients with Oropharyngeal Dysphagia and Their Informal Caregivers: A Delphi Study

“…Because the health crisis has curtailed the majority of management of dysphagia patients and limited consultations and treatment at home. 42 It prevented health professionals from being in direct and regular contact with their patients and, they were unable to involve them in the study. In addition, a potential bias in the perception of needs can be explained through the recruitment of some participants from the researcher’s network.…”

An International Commentary on Dysphagia and Dysphonia During the COVID-19 Pandemic

“…Globally, as soon as patients are stable in acute care, they are often discharged to their LTC setting. These patients can return home with tube feeding, on ventilators with tracheostomies, and may not have had any formal dysphagia evaluation [ 89 ]. However, we were unable to find any published papers reporting COVID-19 outcomes in swallowing and voice in patients in LTC.…”

“…However, we were unable to find any published papers reporting COVID-19 outcomes in swallowing and voice in patients in LTC. Many LTC facilities opted not to transport residents out of the facility for any reason other than life-saving emergency procedures to decrease the spread of COVID-19, ultimately leaving facilities with the only options of clinical swallowing evaluations or mobile FEES and VFSS services for instrumental assessments [ 89 ].…”