You have accessThe ASHA LeaderOn the Pulse1 Jan 2015

The Numbers Game in Older Adult Care

There are more older adults in this country than ever before. Are we adequately attracting and preparing speech-language pathology students to care for them?

    Speech-language pathologists who serve the post-acute adult population speak of their work with a passion that can be infectious—but students and clinical fellows may not identify older adults as their target population of interest. With no more than textbook knowledge of adult disorders, they may find the medical complexities in post-acute settings to be intimidating. Aspiring professionals may not be comfortable identifying multiple disorders and have difficulty blending them into a single plan of care.

    At the same time, however, the population of adults older than 60 is the largest it has been in the history of this country. Longer life spans present complicated medical conditions and increased clinical complexity. Our professional challenge emerges: The next generation of professionals must prepare for clinical and systemic challenges to serve the aging adult population.

    The situation has evolved as increased regulations and budgetary restraints have chipped away at resources and financial support. Compounding these pressures is the need for academic programs to compress more information into two-year programs, and most students’ need to work during school breaks for pay for their education.

    No such thing as a standard patient

    Students destined to work in post-acute care must not only master core content, but also be comfortable with the assorted functional deficits presented by a patient who has multiple diagnoses and medical complexities. There is nothing standard or consistent about this patient population. They require a level of conceptual thinking that may be more than today’s entry-level preparation provides.

    At the minimum, those entering the post‑acute arena need a solid understanding of the swallowing patterns, motor skills and neuronatomy and physiology of a normal aging adult and differentiate these from a disordered process. They need basic knowledge of the stages of dementia and understanding of the progressive nature of many adult diseases. The aging adult offers an opportunity to learn patience, understanding and humility and to accept the decisions made by the aging patient (or family caregivers) with respect.

    Clinical work with the aging adult also is confounded by rapidly changing health care and reimbursement regulations. Understanding the rules and being able to document, code and report outcomes are equally important parts of a clinicians’ job.

    Prepare for the future

    The situation is not, however, hopeless—it’s an opportunity to advance the profession and approach it with the creativity for which we are known. One of the biggest challenges for new professionals is being comfortable with their patient populations. There are many ways to better prepare for that challenge.

    Guest speakers, onsite observations, personal interviews, volunteer experience or part-time employment allow experiential introductions to the world of health care and set a foundation for professional representation with patients, caregivers and family members:

    • Many students have been drawn to the health care settings during classroom presentations. Hearing an invited speaker discuss the treatment of a patient—and the successes and the challenges—is often a catalyst for selecting a population focus.

    • Graduate students in neuro classes acquire a new appreciation for the central nervous system after speaking with a patient who experienced a traumatic head injury.

    • Students observing treatment in a health care setting indirectly learn treatment techniques by observing an experienced professional.

    • Students learn the fundamentals of professional and personal advocacy when seeking and scheduling their own observation opportunities.

    • Seasonal breaks allow for part-time employment or volunteer hours in the dietary, housekeeping or recreational departments in a senior center, nursing home or retirement community.

    Beyond patient experiences, upcoming professionals need to know their personal and professional needs when they look for that first job. They aren’t applying for a “CF placement.” They are applying for the first position in a lifelong career. Applicants should ask about clinical support, professional education, advancement opportunities and how challenges are handled:

    • Trained clinical instructors may be designated to guide and educate.

    • Mentoring programs may be available to new speech-language pathologists.

    • Employers may provide professional growth benefits and ongoing continuing education.

    • Students can take advantage of practicum placements to learn about an organization’s mission, vision, size and systems to determine if these align with the needs and preferences of students.

    We must create a foundation for the next generation to foster the passion and devotion our profession deserves. In the grand scheme, our profession is young. As we look to the future, it is time to focus attention on our clinical training process and to consider some options and opportunities: second-year tracks, an acute and a post-acute medical practicum, expanded specialty areas or a clinical doctorate for certain settings. Collaboratively, employers and academia must ensure adequate training, supervision, mentoring and continuing education. All of us need to be willing to extend whatever is needed to support our new professionals.

    Author Notes

    Joanne M. Wisely, MA, CCC-SLP, is vice president for regulations and compliance at Genesis Rehab Services/Respiratory Health Services. She is an affiliate of ASHA Special Interest Groups 11, Administration and Supervision; 13, Swallowing and Swallowing Disorders; and 15, Gerontology.

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