Introduction

This document outlines the information required, and the expectations of a Hireup Support Worker when providing mealtime management and dysphagia support and of the Client when mealtime management is required on shift.  

Mealtime management requirements vary based on the person’s needs and preferences.

The mealtime management strategies most suited to the Client are to be determined by an appropriate, registered health professional, such as a speech pathologist. This is to be documented in a mealtime management plan, reviewed every 12 months or as otherwise stated by the treating speech pathologist.

This policy aims to ensure the standard of service delivery remains safe and high quality and also to proactively reduce the number of deaths attributed to choking and respiratory infections in persons with a disability, by identifying a person at risk and implementing strategies to prevent their harm.

Hireup Values 

Hireup’s values provide us with the direction in which we engage with our community and develop policy and process across the business. 

We recognise the role safe and enjoyable mealtimes play in contributing to good health, culture and social connection, and acknowledge dysphagia support is only a part of a person’s overall support needs. By upholding the value of ‘the person is the point’ we take an individualised approach to dysphagia support.  

Hireup acknowledges Clients and their families are experts in their individual dysphagia support. Central to this understanding is the principle of ‘championing choice’ and control for Clients to make informed decisions about their dysphagia support and mealtime management. Whilst Hireup is not responsible for the assessment or development of a Client’s mealtime management plan, we support Clients to engage with suitable health professionals and to be involved in the planning, management and training of their dysphagia support and mealtime management plans. 

Definitions 

Support Worker: a person that provides support to the Client, typically in a paid capacity. 

Aspiration: food, fluid or saliva enters the airway and/or lungs before, during or after swallowing. This can occur with obvious signs and symptoms (such as coughing or regurgitation of food or fluid) or silently. 

Dysphagia: a medical term for any difficulty in the swallowing process of food or fluids. It may include weakened muscles or lack of muscle coordination which makes managing food or fluid in the mouth difficult; poor initiation of the swallow; slowed or absent reflexes such as cough; reduced or no sensation in the airway; incoordination of the swallow structures in the pharynx or larynx. 

A person may have dysphagia due to poor posture, varied levels of alertness, cognitive impairment, or ageing. Other related factors that can make eating or drinking difficult include mouth and dental problems, reflux, breathing difficulties, poor appetite, food intolerance, tiredness, poor health and some types of PRN medication. 

Dysphagia can be caused by neurological conditions such as Stroke, Traumatic Brain Injury, Cerebral Palsy, Parkinson’s Disease, Motor Neurone Disease and other degenerative diseases. People with intellectual disabilities can also have dysphagia. 

Early signs of dysphagia may be coughing, throat clearing, gagging, or choking while eating and drinking. This could mean the person is aspirating (see definition), which can cause pneumonia. 

Other signs of dysphagia are repeated or unexplained chest infections and/or raised temperature; unexplained weight loss; dehydration, weak or absent cough or swallow, or drooling. 

Further signs and symptoms of potential dysphagia include eating takes a longer time than normal; the need to cough or clear the throat during or after eating and drinking; frequent complaints of heartburn; shortness of breath when eating and drinking; avoiding some foods because they are hard to swallow. Babies that have difficulty sucking during breast or bottle feeding could have dysphagia.

Mealtime Management Plan: a document that outlines for service users:

• Communication preferences
• Food and drink that is safe to swallow (i.e. texture modified diet or thickened fluids)
• Preparation techniques for food and fluids, as well as medications
• Timing of meals and feeding (for example, allowing suitable time for the Client to complete their meal)
• Best environment for meals (such as a quiet environment with minimal distraction)
• Level of assistance or supervision (to promote and support independence)
• Positioning and posture during eating and drinking (for example, to reduce coughing or swallowing issues)
• Equipment and aids (such as modified cutlery and cups)
• Preferences for foods, tastes and flavours
• Risks to look for and action required to respond to risks, troubleshooting and emergencies 

Oral Hygiene: there is a clear link between dysphagia, poor oral health and increased risk of aspiration pneumonia. It is recommended that Clients are supported to maintain good oral hygiene and regular dental checks. 

Medication Management: there is an increased risk of choking in Clients prescribed sedatives, antidepressants and antipsychotic medications, due to their impact on level of alertness and saliva production. It is recommended that side effects and interactions of all medications are monitored, with respect to their impact on swallowing and choking. This should be part of the annual health review.

Guidelines

Service Provider

As a service provider, Hireup will:

• Work with the Client (or their Account Manager where applicable) to determine the support they require from Hireup, and determine what documentation is required.
• Determine areas of mealtime management that are within the scope of practice for a Support Worker to provide.
• Regularly review the mealtime management plan to ensure the information provided is the most up to date and appropriate.
• Provide Support Workers with written procedures for the Provision of Mealtime Management, in conjunction with the Client (or their Account Manager where applicable) and their treating health professional.
• Ensure Support Workers have access to support plans and ensure these plans are only updated by a registered and relevant health professional, such as a speech pathologist.
• Support Clients to ensure their Support Workers receive regular training and are assessed as competent by a relevant health professional in their individual dysphagia support.
• Identify areas of education and training for Support Workers.
• Provide appropriate training and assessment of Support Workers in relation to the safe provision of Mealtime Management, including regular supervision. 

Support Worker

A Support Worker MAY:

• Perform any task that is listed on the plan, apart from those that must be completed by a health professional. If concerned or unsure, talk to the Client (or their Account Manager where applicable), and contact the Hireup support office for support.
• Access supervision outside of scheduled supervision timeframes by contacting Hireup directly.

A Support Worker MUST: 

• Complete online training modules, provided by Hireup within the allocated time frame unless otherwise specified by Hireup.
• Complete regular training and be assessed as competent by a relevant health professional in each Client’s individual dysphagia support and mealtime management plan.
• Follow the support plan as provided and raise any concerns with the Client (or their Account Manager where applicable) immediately, as well as notify Hireup.
• NOT change any part of the plan or deviate from the plan provided.
• Report any issues or concerns associated with mealtime management (such as increased difficulty with swallow, excessive coughing, watering eyes or changes in behaviour) to the Client, (or their Account Manager where applicable) and/or their health professional immediately, followed by an incident report to Hireup once safe to do so.
• Have up to date First Aid knowledge and techniques for suspected choking, including how to promptly identify choking and clear airways of food.
• Identify any gaps in knowledge and report these to Hireup for further advice.

Client

A Client MUST:

• Provide Hireup with an honest and accurate account of their support needs.
• Provide a support plan to Hireup that outlines their specific mealtime management and dysphagia support requirements, completed by an appropriate, registered health professional.
• Have the plan reviewed by an appropriate, registered health professional when changes occur. At a minimum, the plan should be reviewed every 12 months unless otherwise indicated on the plan.
• Ensure Support Workers receive regular training and are assessed as competent by a relevant health professional in their individual dysphagia support and mealtime management plan.
• Advise Hireup of any changes to support needs, requirements or the mealtime management plan.
• Report any concerns regarding Support Worker’s capability in providing mealtime management support to Hireup for further advice.