Over this past year, we have changed the way we perform instrumental exams, such as FEES or Flexible Endoscopic Evaluation of the Swallow. Both modified barium swallow studies (MBSS) performed in some SNFs and hospitals, and the FEES we provide in other facilities are affected. Since both are considered aerosol events, our policies needed to be modified to comply with the new DOH and CDC guidelines. Carefully adhering to the cleaning and decontamination policies minimize any risks associated with COVID 19.
Treating dysphagia in the skilled nursing facility requires a highly trained individual with a balance of medical expertise, compassion, and an understanding of cultural norms. The job can be incredibly demanding while at the same time equally rewarding. As a Speech-Language Pathologist, I know that it is incredibly important to use every tool available to me to ensure I arrive at the appropriate diet and liquid consistency possible for the patient.
We have been using FEES for over 15 years in skilled nursing facilities in New York State. By providing onsite evaluations, speech therapists receive the opportunity to literally see if a resident is tolerating his or her foods and fluids. Additionally, we evaluate if there are compensatory strategies that ensure safe toleration of a diet, and, hopefully, rule out any evidence of silent aspiration.
When we first began, there were some legitimate questions and concerns raised by SNF operators and administrators who need to see the value in performing these tests in their facilities. Surprisingly, we still run across some facilities that need to see the value in FEES even as it has been a generally accepted testing procedure throughout the industry.
Administrators and owners often need to be reminded that neurogenic dysphagia, one of the most frequent and prognostically relevant neurological deficits in a variety of disorders, such as stroke and Parkinsons is often difficult to identify and measure without an objective study. It allows evaluation of the efficacy and safety of swallowing, determination of appropriate feeding strategies, and assessment of the efficacy of different swallowing maneuvers.
The literature also indicates that FEES is a safe and well-tolerated procedure (Dziewas, et. al. 2016). FEES can be performed in the facility, at the bedside, or wherever the resident typically eats. Unlike a modified barium swallow study, it is performed without exposure to radiation. Also, the test is reimbursable under Medicare Part B in a SNF on a UB-04 as well as most HMO providers.
Got questions about Speech Therapy, FEES testing, Skilled Nursing Facility Rehab, the SLP Component, or maybe something else? We’d love to help! Message us in the space below!
Dziewas, R., Glahn, J., Helfer, C., Ickenstein, G., Keller, J., Ledl, C., … Busse, O. (2016). Flexible endoscopic evaluation of swallowing (FEES) for neurogenic dysphagia: training curriculum of the German Society of Neurology and the German stroke society. BMC Medical Education, 16, 70. http://doi.org/10.1186/s12909-016-0587-3
