DMS At Home FAQ

How can we be sure that patient outcomes will improve?

When returning home or to an Assisted Living or Independent Living Facility, patient stability relies on a complex coordination of abilities, symptoms, and functional processes that reduce the risk of returning to the hospital or Skilled Nursing Facility. Evaluating and managing dysphagia is key to reducing this risk.

In fact, 78% of all patients that return to hospital for avoidable causes do so with five diagnosis—four of which cause or are caused by dysphagia:

• Congestive heart failure
• Respiratory infection
• UTI
• Sepsis
• Electrolyte imbalance (Coleman et all, 2004, Teno et al, 2009)

In order to swallow safely and effectively, there are five bodily systems that must work in coordination. When any of these systems do not function appropriately, the patient has dysphagia, and their risk for repeat illness or returning to the hospital increases. Our unparalleled Dysphagia Systems Test (DST) is the only diagnostic technique that evaluates all five systems required for a safe swallow.

• The muscular system chews and moves the food/liquid through the mouth and into the pharynx to be swallowed.
• The neurological system sends signals to the brain that there is something in the mouth or pharynx that needs to trigger a swallow.
• The cognitive system interprets the signals and puts into action a series of nerves and muscles to transit the food into the esophagus. The cognitive processes of judging safety, making decisions and accessing memory are also required.
• The respiratory system is alerted. To protect the airway, three levels of protection within the pharynx close in order to allow the food/liquid to pass over an otherwise open airway on the way to the esophagus.
• The gastrointestinal system passes the food into the stomach, where it should continue its trip on down to the intestines and not return to the esophagus in the form of reflux.
  • We see 70-80% of our compromised dysphagia patients exhibiting reflux. In the Home Care setting, the reflux alone can cause significant complications when undiagnosed and either untreated or under-treated.

With the goal of improved patient outcomes, DMS At Home features:

• Protocols based on evidence-based research and patient outcome statistics
• A proven track record for patient friendly, CMS compliant, and medical necessity-driven evaluation/treatment documentation
• Functional, practical and effective diagnosis and treatment of dysphagia and its related complications

Who is the typical HHC patient who needs DMS At Home?

The patient at risk for return to the hospital comes in all diagnostic profiles; however, in understanding dysphagia and cognitive decline, one can look at statistics. Dysphagia affects:

• More than 30% of stroke (CVA) patients
• Up to 82% of Parkinson’s patients
• More than 84% of Alzheimer’s patients
• More than 40% of adults aged 65 and older
• More than 60% of patients in hospitals and long-term care facilities
• More than 16.5 million U.S. senior citizens require care for dysphagia as of the year 2010

DMS At Home is appropriate for patients with diagnoses that, when ill managed, can quickly compound into high dysphagia risk and significantly affect outcomes, such as:

• Diabetes
• Post head and neck surgery, including post trach/vent
• Post cardiac event, including surgery
• Hip fracture and/or replacement
• Knee replacement
• COPD, CHF and asthma
• Gastro-Esophageal Reflux Disease (GERD)

A patient with impairment in any one of the five systems of dysphagia (muscular, neurological, cognitive, respiratory and gastrointestinal) is at increased risk for complications including aspiration, choking, dehydration, malnutrition, respiratory ailments and more. Home health patients often suffer from reflux. It is difficult to rehabilitate a person’s dysphagia related to any of the four other systems without managing reflux if it is present.

How does DMS evaluate patients for DMS At Home?

Evaluation is a well-structured process, developed for the optimum patient rehabilitation outcome and care coordination with the home health company. The information assists with prioritizing and organizing care, taking into consideration the highest risks of complications.

• Patients are referred with a physician’s order for DMS At Home.
• The Care Team decides when this best serves the patient and schedules with DMS.
• The first two patient care visits include comprehensive evaluations to establish medical necessity, including speech, language, cognition and dysphagia.
• Patients who exhibit risks for complications from dysphagia are referred for a complete evaluation and swallowing instrumentation utilizing endoscopy (two sessions).
• Based on our results, patients are referred to occupational and physical therapy if not already enrolled.
• Patients are referred back to the Staff SLP (or the DMS SLP if needed) with results of all follow-up tests, and a therapy plan is implemented to treat the dysphagia, cognition and/or voice issues that may have resulted from the dysphagia.
• Caregiver training is designed and implemented with the professional staff.
• Patients are given home training programs to manage their risks on an ongoing basis; this yields the best possible outcome and reduces the likelihood of a return to the hospital.

Why would our facility use DMS if we have our own SLPs?

Dysphagia Management Systems, LLC has been operating since 1992 (previously under the name of BEST Dysphagia Management Services) and as such, has a long history of program development and implementation in more than 30 states nationwide.

DMS At Home evolved after more than 7 years of research and development and more than 35 years experience as a Speech Language Pathologist by founder Carol G. Winchester, MS SLP CCC.

As the nation’s leader in dysphagia management, DMS employs SLP Specialists who are highly skilled in the diagnosis and treatment of dysphagia, speech-language, voice and cognition, above and beyond the training of a staff Speech Pathologist.

DMS Speech Pathology Specialists have:

• Minimum of a Master’s Degree in Speech Pathology
• Certificate of Clinical Competency from the American Speech-Language-Hearing Association
• Minimum of 3-5 years experience with Medical Speech Pathology
• Extensive training and education in Medical Speech Pathology
• Clinical privileges to perform endoscopy according to ASHA standards
• Clinical privileges with DMS

We provide our SLP Specialists with the equipment, processes and expertise to implement DMS At Home.

DMS partners with many major corporations and has the ability to integrate seamlessly into your system. Contact us to learn more!