Guidance for People Sheltering at Home With Swallowing Disorders

With more than half of stroke survivors experiencing swallowing disorders known as dysphagia—and some treatment sessions with speech-language pathologists (SLPs) disrupted by COVID-19—ASHA is encouraging people with these disorders to take continued steps to promote their recovery, safely eat and drink, and avoid rehospitalization due to aspiration pneumonia, a dangerous condition that occurs when someone breathes food or liquid into their lungs or airway.

Dysphagia is a common disorder in older adults resulting from an injury or surgery to a person’s head or neck, dental problems such as missing teeth, and medical conditions or diseases including stroke, Parkinson’s disease, Alzheimer’s disease, and head or neck cancer. For people sheltered at home with the swallowing disorders, ASHA offers the following guidance:

1. See if telepractice sessions are an option. Remote treatment sessions conducted via computer or telephone (“telepractice”) traditionally were not an option for most adults with dysphagia because such sessions weren’t paid for by Medicare or most private insurance companies. However, the COVID-19 pandemic has made this a rapidly changing situation. Check with your SLP to see if they are offering telepractice sessions—and check with your insurance provider, as well, to see if they will cover it. Ask your SLP for the specific billing codes they use so that you can provide these to your insurance company when you call.

2. Continue your strategies—erring on the side of caution. Be diligent in practicing all of the swallowing strategies your SLP provided to you, and be especially conservative in your approach if you aren’t able to see your SLP regularly during this time. Strategies may include taking smaller bites, chewing slower, your position you are in while you eat, or the appropriate textures of foods or thickness of liquids for you. Recommendations are highly individualized, so follow your SLP’s guidance.

3. Stay as active as possible. Move your body as much as you can. The more active you are, the healthier and stronger your body will be. This reduces the chances of getting aspiration pneumonia.

4. Practice good oral care. People with dysphagia should always take good care of their teeth and mouth with proper, frequent brushing—not only to clear their mouth of food particles that can get stuck but also to prevent bacteria that can cause infections and other complications. It’s even more critical now, since dentist appointments may be limited.

5. Stock up on supplies. Some people with dysphagia may have thickening agents that were prescribed or recommended by their SLPs. Thickening agents are added to foods or liquids to make swallowing safer. If you rely on thickeners and have the option to stock up (for instance, if your insurance company will cover a 1-month or 3-month supply at a time), consider ordering extra.

6. Connect socially—virtually. Peer support is a huge part of the recovery process for people with dysphagia. Under normal circumstances, in-person support groups can provide a welcome community for this condition, which can be isolating. Although you may not be able to gather physically, look for opportunities to do so virtually. You can find some opportunities online.