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I’m Theresa Richard. I’ve been a medical speech pathologist for 15+ years, I’m a Board Certified Specialist in Swallowing and Swallowing Disorders, and I’m incredibly passionate about evidence-based practice and equally considering patient preferences with clinical experience and research.

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How to form your instrumental lovin’ #SNFsquad (The Step-by-Step Guide to Advocating for Access to Instrumentation Part 4)

by | Jul 14, 2017 | The Step-by-Step Guide to Advocating for Access to Instrumentation

Send me this 12 page guide so I can get to advocating already!


Did you know that the prevalence of dysphagia has been estimated to be as high as 68% of all residents in long term care facilities? (Steele, 1997) It is estimated that over 45% of SNF residents with dementia suffer from dysphagia (Sura et al., 2012) and those who can not follow 1 step directions have a 57% increased chance of aspirating thin liquids (Leder et al., 2009)

Those are just a few of the statistics that the National Foundation of Swallowing Disorders ( shared during Dysphagia Awareness Month in the month of June.

I’ll be honest, I assess swallowing disorders daily, and I had no idea that the prevalence was that high.

With the new political climate and the transition towards performance based outcomes coming down the pike, you have no excuse not to advocate for and use instrumentation.

If you’ve been sitting in the dining room watching your patients eat, writing the same lingual exercises for the entire rehab hallway, then yes the new shift to performance based outcomes should have you very worried. But if you are an advocate for instrumentation, understand the underlying pathophysiological deficits that your patient is presenting with, and then use evidence based treatment strategies such as IOPI, EMST, CTAR, etc., then you really shouldn’t be that worried!

The buildings that have access to instrumentation have SLPs that are highly respected, and have built several personable, trusting relationships throughout the facility. Start laying your bricks.

So personally I would not even work in a facility that didn’t allow for swallow studies, but maybe this SNF is the best situation for you right now. Your kid’s school is right next door, they allow you to have a flexible schedule, and the pay and benefits are incredible, BUT, they don’t let you get swallow studies for your patients. No biggie, you’ve just got some work to do. Since you plan to stay at this facility for the foreseeable future, why not get to know everyone in the building? Sure you may not jive with everyone, but you never know what you’ll have in common, or that your son is in the same class as the DON’s. You’d never know that unless you opened your big ol’ speech therapy lovin’ mouth. Relationships are what make the world go round. They build trust. And when you have trust, it’s a heck of a lot easier to convince a colleague to bring a mobile swallow study service provider in for a meeting.

Think about if you were the DOR and your PT colleague came to you and said they wanted to buy this new treadmill, you’d probably say hell no too, you people got enough stationary bikes! BUT, if they constantly keep up with the research, have open lines of communication with other professionals, can demonstrate the improved outcomes and cost effectiveness of said treadmill, then they will be the one to get the meeting and the capital dollars when it’s opened up. Investing a little get-to-know-you time can go a long way when advocating for your profession.

After you’ve invested some time in getting to know your colleagues at the SNF (i.e. the employees of the SNF, NOT your rehab company), I want you to be so overly prepared as to why you need access to instrumentation, and so well versed in how this all works, that it just casually comes up in conversation. Take the time to write the email, make the phone call, invite the colleague for lunch, you don’t have time? Turn off Facebook for 30 minutes, there now you have time. You were going to go sit in your car during lunch anyways and listen to Howard Stern reruns? Great, take your peanut butter and jelly back inside and go make some conversation.

Below I am going to give you some ways that you can use to open up the lines of communication between you and your colleagues, that you can hopefully leverage in to a conversation about increased access to instrumentation with the administrator.

1. Get to know your colleagues on a little more personal level. Say hi in the hall way, comment on their cute little family picture in the office, see them with the Buffalo Bills lanyard around their neck? Comment on the game. Try to find something to begin building a personable, trusting relationship.

2. Send an e-mail. Emails are a little less personable, but worded the right way, can at least get you a meeting. If you’re the ultimate introvert, this may be a good icebreaker. See below for a sample.

3. Short on time? Not even sure how you will find the time “to get to know your colleagues?” Just start with small talk in the hallway. Baby steps here.

4. Comment on your colleagues family pictures in their office.

5. Do you know if you have something in common or a mutual interest? Great! Tell them about it!

6. Turn Facebook off for 10 minutes on your break and go bring someone a nice treat. Flattery gets you everywhere 😉

7. Do you usually go sit in your car at lunch? Go sit in the break room!

8. Phone calls seem petty when you work in the same building, but some people prefer to be called. Ask if they have a few minutes to chat with you.

9. Invite a colleague out for coffee, lunch, or best of all.. happy hour!

Finally, after you’ve bounced the idea of instrumentation off all of your colleagues, and they’ve encouraged you to set up a meeting with your administrator, you may need to email him if your schedules just don’t sync up. Emails are somewhat informal, but can also be very powerful if positioned the right way. If you’re the ultimate introvert, this may be a good icebreaker for you.

One final note, if you have mobile FEES/MBSS in your area, contact them ahead of time, and ask for some information that you can research. They usually will come to the facility and meet with you and the administrator and it only makes you look better, if you are all on the same team and speaking the same language.

Don't have a mobile FEES/MBSS company in your area? You should probably start one 😉

Did you miss the beginning of this series? Go learn WHY you need access to instrumentationWHO you should actually advocate to, and HOW much all of this craziness costs!


Leder SB, Suiter DM, Lisitano Warner H. Answering orientation questions and following single-step verbal commands: effect on aspiration status. Dysphagia. 2009;24(3):290–5

Steele, Catriona M., et al. “Mealtime difficulties in a home for the aged: not just dysphagia.” Dysphagia 12.1 (1997): 43-50.

Sura L, Madhavan A, Carnaby G, Crary MA. Dysphagia in the elderly: management and nutritional considerations. Clinical Interventions in Aging. 2012;7:287-298. doi:10.2147/CIA.S23404.


If this entire post is completely greek to you, or if you would just like some additional support while trying to stay afloat on dysphagia island, please consider joining us for the Medical SLP Collective. We provide brand new weekly resources in the form of handouts and videos, a panel of experts to answer ALL of your Medical SLP questions (anonymously, and not limited to dysphagia) and monthly webinars for ASHA CEUs.