Case Study: The Grove at Valhalla Rehabilitation & Nursing Center (October 2015)

Patients Age: 63
Admission Date: 4/1/14
Admitted From: WMC
Discharge Date: 10/29/15
Length of Stay:
Discharge To:
Reason For Stay: Continued Rehab
How did this patient hear about The Grove?: Hospital SW

Resident was admitted to the facility in April, 2014. Upon admission he was barely verbal and extremely weak, received GT feeds and was NPO. Thus, when I started working at The Grove on May 4, 2015 this resident had already been a patient at the facility for over a year.
When we began working together , the resident was still dependent on GT feeds , remained NPO and had persisting difficulty managing his saliva. Trials of small amounts of puree dessert continued to find him coughing. We embarked on a vigorous program of swallowing exercises to improve swallow function and therapy was discontinued with him receiving 1 puree item in the AM and 1 at the noon meal as forms of recreational feeding, along with a cup of honey thick juice.
After approximately 1 month the resident had made strides in physical therapy and had begun to stand and take a few steps. It was felt that improved physical status could be a positive impact on swallow function, and concomitantly, persistent coughing seemed to have abated sufficiently to reembark on a dysphagia therapy program.
Once again, there were hills and valleys in his swallowing ability and food tolerance. Puree items were increased to 2 in the AM and 2 at the noon meal with nectar thick liquids. However, it was taking an extraordinary length of time for the resident to finish the items that were provided and it did not bode well for his ability to manage increasing amounts of food. In consideration of this fact, I thought that since he would probably remain dependent on GT feeds and would only be able to tolerate a small amount of food by mouth, a trial of his native Indian food would at least improve his quality of life and ability to participate in his culture, albeit on a limited level.
The resident’s wife was an active and avid ally in this process. I instructed her on ground texture foods we could trial. She brought a variety of foods every day and thus the trials began. Much to my delight, his manner of intake began to improve. There continued to be hills and valleys in swallow function but we proceeded slowly and carefully to insure his health and well being. Little by little he made great strides and dysphagia therapy continued with trials of ground and chopped textures. The resident’s swallow patterns began to approach what would be considered functional levels. Ultimately in mid September his diet was upgraded to chopped consistency with nectar thick liquids
It seemed to me from resident’s progress that, with continued therapy and attention to improved swallow function and compensatory strategies, the possibility existed of his achieving a regular consistency diet with thin liquids. Therefore, we continued to work diligently. The resident persevered with the support and encouragement of his wife who continued to prepare the foods for her husband as I suggested.
Ultimately, on September 30, 2015 the resident’s diet was upgraded to regular consistency with thin liquids. He now relies solely on food by mouth and GT feeds have been discontinued.
AMAZING job by our entire team, specifically our speech/swallow therapist.