Problems with swallowing, feeding, diet, and nutrition are common in the medically fragile and frail elder and often emerge during an acute event when prognosis is unclear. Thus, solutions are limited, fraught with emotion, and made with limited evidence regarding the most appropriate goals of care. This comprehensive presentation will discuss the impact of illness and deconditioning on swallowing, review evidence-based interventions, and provide a clear framework to guide the practitioner, team, and family with decision-making that is appropriate and realistic but more importantly patient-focused. Information on how to communicate and document care plans and address challenging situations will be discussed. Case presentation will be an integral part of the presentation to illustrate these concepts. Offered for 0.25 CEUs – 2.5 contact hours.
This course was included in the material of a previously offered eCourse – #e108: Charleston Swallowing Conference Home Study: Evidence-Based Dysphagia Management.
The content of this online CE course does not focus exclusively on any specific proprietary product or service. Presenter financial and non-financial disclosures may be found in the Presenter & Disclosures area.
Video PowerPoint presentation with author narration & downloadable handout.
Paula A. Sullivan, MS, CCC-SLP, BCS-S, currently is a Senior Speech-Language Pathologist in the Department of Neurology/Speech Section, North Florida/South Georgia Veterans Health System in Gainesville, FL. Paula's clinical expertise and research are focused on swallowing disorders in head and neck cancer and at end-of-life. She has been affiliated with numerous comprehensive cancer centers, including H. Lee Moffitt Cancer Center, Tampa, FL, Sylvester Cancer Center, Miami, FL, and the University of Wisconsin, Madison, WI. Paula also has participated as part of numerous clinical research trials in swallowing.
Paula served as a co-regional primary investigator for the largest controlled, randomized research trial in oropharyngeal dysphagia funded by the National Institutes of Health (Protocol 201). Protocol 201 examined the effectiveness of chin down and thickened liquids in individuals with dementia and Parkinson's disease both with and without dementia. Other research activities include collaborating with Dr. Jeri Logemann on numerous National Cancer Institute clinical swallowing protocols in head and neck cancer. Additionally, Paula has published numerous articles, book chapters, and co-authored books, including Swallowing Intervention in Oncology and the Easy-To-Swallow, Easy-To-Chew Cookbook. She also has co-authored multiple national guidelines, directives, and policies relating to oropharyngeal swallowing disorders for both the Veterans Health Administration and the American Speech-Language-Hearing Association (ASHA). She is a board recognized specialist in swallowing and swallowing disorders. Paula is an ASHA Fellow and former coordinator of ASHA's Division 13, Swallowing and Swallowing Disorders. She was named "2013 Clinician of the Year" by the Association of Veterans Affairs Speech-Language Pathologists.
Financial — Paula Sullivan is a coauthor of the text, "Easy-To-Swallow; Easy-To-Chew Cookbook"; receives royalty payments.
Financial — Paula Sullivan is a presenter of online CE courses sponsored by Northern Speech Services; receives royalties.
Nonfinancial — Paula Sullivan has no relevant nonfinancial relationships to disclose.
This program is offered for 0.25 ASHA CEUs (Intermediate Level; Professional Area).
ASHA CEUs: NSS online courses are registered with ASHA and are offered for ASHA CEUs. The number of ASHA CEUs is noted above. Note that 0.1 ASHA CEU = 1 contact hour = equals 1 CEE.
ASHA CE Registry: During the enrollment process, if you select to receive ASHA credit for this course and if you provide your ASHA number, NSS will automatically submit your CEU information to the ASHA CE Registry after successful course completion (80% on post test). This submission happens once per month, during the first week of the month. For example, if you complete your course on November 7th, NSS will submit all November online course CEUs to ASHA during the first week of December. When ASHA inputs the information into their database, they will mark the course as completed on the last day of the month in which it was completed, so November 30th using this example. The certificate of completion available for you to print immediately, however, will reflect the actual completion date, November 7th in this example. Due to ASHA processing procedures please allow 2-3 weeks, from the submission date, for the course to appear on your ASHA transcript.
ASHA CEUs: Attendees must meet at least one of the following conditions in order to be eligible to earn ASHA CEUs:
If an attendee is not an ASHA member or CCC holder but meets any of the above criteria, they may inform the ASHA CE Registry of their eligibility by visiting this site.
Licensing Boards: Most state licensing boards DO accept CEUs earned online (usually classified as home-study credits). Some state boards do, however, place a limit to the number of credits that can be earned via home study/online courses. For the most current information, we suggest that you contact your licensing board or agency to verify acceptance policies and/or any credit limits related to home-study courses prior to registering for this course.
Additional accrediting agencies by which Northern Speech is an approved CE provider:
Course Completion Timeframe: You have unlimited time to complete this online course. You may log off and log on as you wish in order to complete all sections of this course.
Content Access: Access to course materials and content does not expire, even after completing the post test. You may continue to review course material by logging into your NSS account, clicking the My Online Courses tab, and then viewing your desired course.
Certificate of Completion: On successful completion of the post test (80%), a certificate will be immediately available for download and/or printing. This certificate will include your name, date of completion (based on Eastern Time Zone, USA/Canada), and number of contact hours (CEUs / CEEs). Please note that CEUs are awarded on the date of successful test completion, not the date of course enrollment. Please ensure that you successfully complete the post test prior to any licensure renewal dates.
ASHA CE Registry Submission: During the enrollment process, if you select to receive ASHA credit for this course and if you provide your ASHA number, NSS will automatically submit your CEU information to the ASHA CE Registry after successful course completion (80% on post test). This submission happens once per month, during the first week of the month. For example, if you complete your course on November 7th, NSS will submit all November online course CEUs to ASHA during the first week of December. When ASHA inputs the information into their database, they will mark the course as completed on the last day of the month in which it was completed, so November 30th using this example. The certificate of completion available for you to print immediately, however, will reflect the actual completion date, November 7th in this example. Due to ASHA processing procedures please allow 2-3 weeks, from the submission date, for the course to appear on your ASHA transcript.
Purchase Orders: Purchase orders are NOT accepted when registering for online courses. Payment must be made online in the form of a credit or debit card payment.
What is an Online Course? Our Online Courses consist of video, audio, and/or text content and are offered for ASHA CEUs. Unlike a webinar, which requires participants to be logged on and at a computer at specific times, our Online Courses are available to you at any time, from any device, via your NorthernSpeech.com online account. You may work at your own pace and start and stop your course as you wish. Your course will conclude with a short post test. On successful completion of the post test (>80%), a printable certificate of completion is presented to you.
Receiving CEUs: Northern Speech is an ASHA CE Provider and our online courses are registered with ASHA and offered for ASHA CEUs. Please note that successful completion of the online post test is required prior to the awarding of CEUs. Please contact your state licensing board for acceptance policies related to CEUs earned online.
Registering for an online course: You may browse all online courses by clicking the Continuing Education tab above, then Online Courses. Once you find a course, click Enroll Now, and you will be asked to either log into your existing Northern Speech account or create a new online account. Once you’ve entered your account information and provided your credit card payment, your course will be immediately available to you.
Accessing your purchased course or returning to a purchased course: You will be able to access your online course by logging into your Northern Speech account and then clicking the My Online Courses tab on your profile screen. Click the course you would like to start or to resume. From there, proceed through the course sections until you are ready to complete the post test. You do not have to complete your course all at once. You may log on and off as you wish.
Testing requirements: Each online course concludes with a post test consisting of multiple choice or true & false questions. Scores of 80% or greater are required for successful course completion and awarding of CEUs. You may revisit course materials and retest as needed to achieve a passing score.
Number of CEUs offered: We offer courses from 1 to 21 contact hours. Each course will note the number of CEUs offered. Please note that 0.1 CEU = 1 contact hour = 1 CEE.
State licensing boards and online CEUs: NSS is an ASHA CE Provider and most state licensing boards DO accept ASHA CEUs earned online (usually classified as home-study credits). Some boards do, however, place a limit to the number of CEUs that can be earned via home study/online courses. For the most current information, we suggest that you contact your licensing board or agency to verify acceptance policies and/or any CEU limits related to home-study courses prior to enrolling in an online course.
Course formats: Our course formats include: text, audio, video, and PowerPoint with author narration. Each course will note the format on the course description page.
Course handouts: Most of our online courses provide a link to download the accompanying handout as a PDF file.
Group discounts: Groups of 3 or more are eligible for a 20% discount on each registration on most of our online courses. To receive this discount, registrations need to be processed together via the "Group Rates" tab on the Online Course of your choice.
Computer requirements: For our online courses to function best, we recommend that you update your computer to include the newest version of your Internet browser (Safari, Chrome, Firefox, Edge, Internet Explorer, etc.) and newest version of your computer's operating system. Also a high-speed Internet connection is recommended (cable or DSL). Speakers or headphones will be required for many of our courses as many contain audio components.
Course Cancellation Policy: A purchased online course can be exchanged, refunded, or transferred to another individual if contact is made with NSS (via phone or email) within 30 days of purchase and the course materials have not been viewed or downloaded.
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"I enjoyed the facts re: rates of aspiration and pneumonia." – A.S. (Feb. 2020)
"I appreciated the suggestions for speaking with families." – M.P. (Jan. 2020)
"Overall, all the information is beneficial in organizing the thought process for completing swallow evals and providing recommendation or rather information with the elderly. In the acute care setting, it is difficult to make decisions for the long term when a patient is so sick. This information helps to organize where to go with feeding and family choices upon discharge. I have obtained a lot of key phrases/concepts to utilize in report writing that supports family decisions for PEG tube placement." – M.B. (Dec. 2019)
"Very thorough and practical for my caseload in the community and LTC. I especially appreciated the details on frailty, how to word SLP suggestions/recommendations, and review of risk factors." – L.G. (Dec. 2019)
"The discussion regarding patient choice regarding tube feeding was most helpful. I liked the course's convenience and content." – P.T. (Nov. 2019)
"I enjoyed the strategies to explore when assisting patients with advanced dementia. I liked the use of decision making tools to make informed decisions re: feeding tube usage." – C.E. (July 2019)
"I really benefitted from the step-by-step guides to how to address these difficult topics with family members, as well as how to document various treatments in records." – K.B. (June 2019)
"The discussion on when to proceed or not when family doesn't comply was especially helpful. My facility is a tad wishy washy. I liked that the course was clear and concise." – R.A. (June 2019)
"Expertly done! I thought the course was perfect. I especially appreciated the discussion on decisions to avoid using instrumental assessment in some cases. I get a tremendous amount of push back from physicians who just want the test done to prove aspiration so a feeding tube can be justified. It is a tough battle." – C.S. (Mar. 2019)
"This course provided a clearer understanding of the need to review all options before making suggestions related to FT and decreasing the use of alternate diets with AD." – J.B. (Mar. 2019)
"Very clear and relatable! Going over the feeding tubes in dementia/medically fragile patient and how to manage the decision-making process were most beneficial." – F.T. (Dec. 2018)
"A lot of great information on how to have these hard discussions in the acute care setting. Great examples, resources, and references. Thank you!" – C.N.A. (Nov. 2018)
"I liked the relevance, case studies, and overview of literature and updated research." – J.R. (Aug. 2018)
"The techniques to promote nutrition and weight gain in the dementia population was most helpful. I liked the inclusion of ethical implications." – M.L. (June 2018)
"I liked the ideas for assisting family with end of life decisions. Excellent visuals in the course." – S.D. (June 2018)
"I enjoyed the Palliative information and found the course was easy to follow and very informative." – M.M. (Apr. 2018)
"I liked the clinical resources for decision making, and I enjoyed the questions/review later on." – K.W. (Dec. 2017)
"Going over how to discuss with patients/families during the decision-making process regarding comfort eating vs alternate means of nutrition/hydration vs altered diets/liquids was most beneficial." – A.G. (Dec. 2017)
"Excellent overview of a complex clinical challenge and how to support patients, families and staff with difficult decisions. I liked the multiple study citations to support theoretical and clinical decisions." – A.W. (Dec. 2017)
"Learning more about the research behind QOL in those with feeding tubes and also the consequences of feeding tube placements was most beneficial. Great examples and videos of MBSS." – P.E. (Nov. 2017)
"Very practical and applicable immediately in my hospital based practice." – G.E. (Nov. 2017)
"The Rosenbek study review was most beneficial. This course was helpful in understanding the SLP's needed role in palliative care support." – P.T. (Oct. 2017)
"Going over how feeding tubes are not necessarily reducing a patient's risk for aspiration was really helpful. Great info to give families during palliative care consults." – K.M. (Oct. 2017)
"I appreciated the resources for family education. I like that the course was relevant to my setting." – M.M. (Oct. 2017)
"I really enjoyed the discussion that a positive eating environment in a NH can have such a great impact on the residents. I expected more specifics or case studies on how to handle family situations. This is a difficult subject, and I felt the speaker could have added more ideas for those of us 'in the trenches.' " – S.O. (Sept. 2017)
"The resources were great. Probably the most beneficial course I have ever taken!! Very informative and speaker is so knowledgeable and experienced." – R.M. (Aug. 2017)
"The case studies were particularly informative, as well as the decision-making process involved in the SLP's POC. I liked the step-by-step process for guiding others to help them make decisions, as well as the resources provided." – P.F. (July 2017)
"While I have never been one to recommend a feeding tube without it being the very last option, it is beneficial to have the added resources to show not only the family, but also NH nurses and administrators who often attempt to pressure SLPs (in my experience) in to recommending FTs because it's easier or they can skill a patient because of it. I look forward to sharing my new information with those in the near future." – A.B. (June 2017)
"The decision-making guide for use with patients, family, and staff was the best part. I enjoyed the course clarity, topic thoroughness." – M.M. (May 2017)