Swallowing Referrals

Problems with swallowing are often referred to as ‘dysphagia’.

We accept referrals for people who have dysphagia at the level of their mouth (oral) or throat (pharyngeal).

People with dysphagia may have problems with storing food or drink in their mouth, losing food or drink out of their mouth, coughing or choking when eating or drinking and a wet voice or increased shortness of breath when eating and drinking.

The risks of a swallowing problem include dehydration, malnutrition, weight loss, choking and aspiration (breathing in food or drink). Aspiration can lead to chest infections and pneumonia.

Swallowing problems can be very distressing for the person involved.

If you think one of your residents has a swallowing problem, you should:

Talk to your medical team about whether the person needs a review
Monitor for signs of a chest infection and contact their GP for review if this is suspected
Review their supervision needs at mealtimes especially if there is a risk they might choke
Make sure they are being weighed regularly to check they’re not losing weight
Keep food and fluid charts are in place to check how much they’re eating and drinking
If there are concerns over weight loss and/or intake, follow the Food First initiative and consider referral to dietetics if the person is still losing weight
Start monitoring coughing. Charts for this can be found here
If the person needs referring to our service, use the referral form here. It is helpful if you include a day or two of completed coughing monitoring charts.
Review their care plan and consider avoiding high risk foods to reduce choking risk whilst you are waiting for us to contact you. Our ‘Introduction to Swallowing Difficulties' leaflet and diet leaflets (click the links in the side bar of this page) explain softer and easier diet levels. This should be done with your resident’s consent or agreed in their best interests if they cannot give consent. This should be clearly documented in their care plan and you should aim to be least restrictive in any changes to their diet.

Making a referral

Please make sure all sections on our referral form are completed
It is really important that the information to help prioritise a swallowing difficulty is completed accurately. This is so we can triage referrals appropriately and ensure those most at risk are seen quickly.
We aim to complete a paper triage of all referrals within 2 working days and priority telephone assessments completed within 10 working days.
Other referrals will be informed of the current wait for telephone assessment by letter.
If your resident deteriorates whilst waiting for assessment, please contact us so we can reprioritise if needed.

Telephone Assessment

When we call to complete our telephone assessment for swallowing referrals, we will need information about the following:

The person’s ability to make informed decisions about their care and communication needs
If they have a power of attorney for health
Their medical history and current state of health
Their current level of mobility and ability to do activities of daily living such as washing, dressing, feeding themselves
Any issues swallowing medication
Any food allergies
What consistency food and drink they are having.
What swallowing difficulties they are presenting with e.g. coughing, choking, storing food in their mouth etc. and how often this happens
Any choking episodes that have needed assistance.
Dates of any chest infections needing antibiotics.
Their current weight and height.
The amount they are eating and drinking.

Inappropriate referrals

End of life
If the person is at the end of their life, please talk to their GP or medical team about the whether it’s appropriate to refer them. It’s normal that people will want to eat and drink less if they are dying and the main aim is to keep them comfortable and maintain their quality of life. Referrals to our service would usually only be appropriate where the person wants to eat and drink and they are in significant distress, even when supported with sips of fluids or softer food consistencies.

Medication
If a resident is having problems swallowing medication then this should be managed by their GP or pharmacy team. We do not accept referrals for problems only with swallowing medication.

Chewing
If someone has problems chewing due to issues with their teeth they don’t usually need a referral to us. Care homes can provide softer diet options as long as this is clearly documented in the person’s care plan as per the care home policy and managed in line with the Mental Capacity Act 2005.

Stomach or oesophagus
We do not see people who have swallowing problems due to a problem with their food pipe (oesophagus) or stomach. If someone is vomiting, retching, reporting pain in their chest when swallowing or having issues with reflux then they should be seen by their doctor.