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Registration Number: {{org_field_registration_no}}

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Supporting People with Swallowing Difficulties Policy

1. Purpose

The purpose of this policy is to ensure that {{org_field_name}} provides safe, effective, and person-centred support to individuals experiencing swallowing difficulties (dysphagia) in their own homes. It outlines how we assess, monitor, and manage risks while promoting dignity, hydration, nutrition, and quality of life. This policy supports compliance with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (as amended), including Regulation 9 (Person-centred care), Regulation 10 (Dignity and respect), Regulation 11 (Need for consent), Regulation 12 (Safe care and treatment), Regulation 13 (Safeguarding service users from abuse and improper treatment), Regulation 14 (Meeting nutritional and hydration needs), Regulation 17 (Good governance), Regulation 18 (Staffing), and Regulation 20 (Duty of candour). This policy must be applied alongside the Mental Capacity Act 2005 (including best-interests decision-making where required) and reflects the CQC’s assessment of Safe, Effective, Caring, Responsive, and Well-led outcomes.

2. Scope

This policy applies to all home care staff, including support workers, team leaders, and care coordinators involved in the planning or delivery of care for individuals who have been diagnosed with or are suspected of having swallowing difficulties. It covers all aspects of food and fluid intake, medication administration, and oral hygiene support.

3. Related Policies

• CH07-Person-Centred Care Policy
• CH11-Safe Care and Treatment Policy
• CH14-Receiving and Acting on Complaints Policy
• CH18-Risk Management and Assessment Policy
• CH34-Confidentiality and Data Protection (GDPR)-Service User Policy
• CH36-Initial Assessment and Care Planning Policy

4. Policy Statement

{{org_field_name}} recognises that swallowing difficulties can have serious health consequences including aspiration pneumonia, malnutrition, dehydration, and choking. We are committed to supporting individuals in a way that is tailored, clinically informed, and dignified. Staff are trained to recognise the signs of dysphagia, follow clinical guidance, and escalate concerns promptly.

5. Key Procedures and Implementation

a. Identification and Assessment

Swallowing difficulties may be identified through initial assessments, medical diagnoses, or observations during care delivery. Signs include coughing during or after meals, drooling, a ‘gurgly’ voice, reluctance to eat, or repeated chest infections. Any such concerns must be reported immediately to the Registered Manager {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}} and the individual’s GP or speech and language therapist (SALT). A referral is made for a formal swallowing assessment and risk evaluation.

Consent must be sought before any assessment activity, referral, or sharing of information with health professionals, unless there is a lawful basis to share without consent. Where the person may lack capacity to consent to aspects of their nutrition, hydration or swallowing support, staff must follow the Mental Capacity Act 2005: presume capacity, provide practical support to help the person decide, assess capacity for the specific decision where required, and record the outcome. If the person lacks capacity, a best-interests decision must be made and recorded, including involvement of family/representatives and relevant professionals as appropriate.

If staff observe signs that suggest an immediate risk of choking or aspiration (for example repeated coughing during intake, wet/gurgly voice after swallowing, breathlessness, distress, or reduced alertness), staff must stop oral intake for that episode, ensure the person is safely positioned, and escalate urgently to the Registered Manager and the relevant clinician (GP/SALT) for advice. Any interim measures taken must be documented in the daily notes and communicated to all staff supporting the person.

b. Care Planning and Documentation

Once a diagnosis is confirmed or guidance is provided, a personalised care plan is developed. It details safe foods and fluids, positioning, feeding techniques, supervision requirements, and communication needs.

For people with dysphagia, the care plan must include, as a minimum:

• the most recent SALT/clinical recommendations (including the exact texture level and fluid consistency level, and any permitted exceptions)
• specific preparation instructions (including thickener brand/type, method, quantity and standing time where applicable)
• positioning requirements and how long the person must remain upright after intake
• the level of supervision required, prompts/cues needed, pace of intake, and portion guidance
• any adaptive equipment required (for example specialist cups/cutlery) and how it must be used
• oral care requirements (what is needed, frequency and products) to reduce aspiration pneumonia risk
• medication guidance linked to dysphagia (including whether any medicines require alternative formulations and that tablets must not be crushed/modified unless authorised)
• escalation triggers and who to contact (for example signs requiring SALT/GP review or urgent care)
• how risks, choices, and consent/capacity/best-interests decisions have been recorded.

The care plan must be clear, accessible, and updated after every review or change in condition. The individual (or their representative) is fully involved in the planning and consent process.

c. Staff Training and Competency

All staff supporting individuals with swallowing difficulties receive mandatory training, including signs of dysphagia, IDDSI (International Dysphagia Diet Standardisation Initiative) levels, safe feeding techniques, and emergency responses for choking. Staff are observed in practice and assessed for competence regularly. New or agency staff are briefed before providing care to individuals with dysphagia.

No staff member may support a person with identified or suspected dysphagia unless they have completed dysphagia awareness training and have been assessed as competent for the tasks they are undertaking (for example: preparing thickened fluids, supporting feeding, or monitoring for aspiration). Competency reassessment must take place at least annually, and sooner where there is an incident, a change in SALT/clinical guidance, or any concern about practice. Staffing arrangements must ensure there are enough competent staff available at scheduled meal and drink times to safely meet people’s needs.

d. Safe Meal Preparation and Support

Where meals are prepared or served by staff, food and drink must be consistent with the texture and fluid thickness specified by SALT or clinical professionals (e.g. minced and moist, pureed, thickened fluids). Thickeners must be used according to prescription and manufacturer instructions. Staff must check expiry dates and ensure no deviation from the prescribed level occurs. All food must be served at an appropriate temperature and in a calm, unhurried environment.

Where the service is responsible for preparing meals or thickening drinks, staff must follow a two-step verification process: (1) confirm the required IDDSI level/consistency from the current care plan immediately before preparation, and (2) document that the correct level was provided for that episode of care (for example in daily notes and/or intake charts where used).

To reduce the risk of error, thickeners must be stored securely, clearly labelled, and used only by trained, competent staff. Any deviation from the prescribed texture or fluid consistency must be treated as a safety incident, recorded, escalated without delay, and reviewed to prevent recurrence.

e. Positioning and Supervision

People with swallowing difficulties must be supported to sit upright at 90 degrees during meals and for at least 30 minutes after eating or drinking. Staff must remain present throughout to monitor for signs of distress, fatigue, or aspiration. If the person is supported in bed, their position must be adjusted to facilitate safe swallowing. Staff must not multitask while supervising meals.

f. Medication Administration

Staff must not crush or modify tablets unless authorised by a pharmacist or prescribing clinician. Any authorisation to crush, open, disperse, or otherwise alter medicines must be documented (for example written pharmacy advice, GP instruction, or a current medicines administration protocol), and the care plan and MAR must clearly state how each medicine is to be taken safely. Staff must not mix medicines with food or thickened fluids unless this is explicitly authorised and risk assessed. A medicines review must consider whether the medicine remains required and whether safer formulations (for example liquid, dispersible, transdermal, or alternative routes) are available. Where swallowing difficulties affect medication intake, a medication review must be requested to explore liquid alternatives or safe modifications. Staff must record all administration and any difficulties in swallowing, refusal, or spillage.

g. Emergency Response

If a person chokes or shows signs of aspiration (e.g. gasping, blue lips, distress), staff must immediately follow emergency procedures, including calling emergency services, administering back blows or abdominal thrusts (if trained), and reporting the incident. The incident must be recorded, and family or advocates informed.

Where the incident meets the definition of a notifiable safety incident, the Registered Manager must ensure the statutory Duty of Candour is followed. This includes informing the person (and/or the relevant person) as soon as reasonably practicable, providing an apology, explaining what is known at that time, describing what will be investigated, and sharing the findings and actions once complete. All Duty of Candour actions must be fully documented.

Following any choking or suspected aspiration event, a management review must be completed to identify immediate and contributing causes (for example: care plan clarity, staff competency, food/fluid consistency, positioning, supervision levels, fatigue, environment, and timing). The care plan and risk assessment must be updated as required, and learning must be shared with staff and incorporated into training, supervision, and audit activity.

h. Monitoring, Review, and Escalation

Care plans for people with swallowing difficulties must be reviewed monthly or sooner if health changes are observed. Regular weight checks, hydration logs, and fluid/food intake charts may be implemented. Concerns are escalated to healthcare professionals for reassessment. Family members and external professionals are encouraged to provide input.

A review must take place immediately (without waiting for the monthly review) where there is: a choking/aspiration incident; repeated coughing, throat-clearing or wet/gurgly voice during or after intake; recurrent chest infections; unexplained weight loss; dehydration concerns; persistent refusal of food or drink due to difficulty; or any change in neurological, respiratory, or cognitive status that may affect swallowing.

The provider will complete regular quality checks to demonstrate good governance. This will include monthly checks that dysphagia care plans and risk assessments are current and consistent with SALT/clinical advice; spot checks that medicines guidance is clear where dysphagia is present; review of incident themes and completion of action plans; and monitoring of training and competency compliance for staff supporting people with dysphagia.

i. Dignity, Choice, and Cultural Considerations

Staff must ensure the individual is offered culturally appropriate meals that align with their preferences and dietary needs, while still meeting safety standards. People must be offered choice within the scope of their care plan, and their dignity must be protected during mealtimes, particularly where support with feeding is required.

6. Responsibilities

All staff are responsible for following care plans and seeking advice when unsure. Team leaders and managers ensure that clinical advice is implemented, training is up to date, and risks are monitored. The Registered Manager has overall accountability for ensuring that systems are in place to identify, assess, and support people with swallowing difficulties safely.

7. Record Keeping, Notifications and Information Sharing

All dysphagia-related assessments, referrals, care plan changes, risk assessments, training and competency sign-off, intake monitoring records (where used), and incident reviews must be recorded contemporaneously and stored in line with data protection requirements and organisational policy.

The Registered Manager is responsible for ensuring that incidents are reviewed, actions are completed, and any required notifications to external bodies (including CQC where applicable) are made within required timescales. Records must evidence decisions taken, actions completed, outcomes, and learning.

Information sharing with health professionals and family/representatives must follow consent and Mental Capacity Act requirements and must be documented, including what was shared, with whom, the purpose, and the date/time of the communication.

8. Policy Review

This policy will be reviewed annually or earlier if clinical guidelines, CQC expectations, or best practices change. Any updates will be communicated to staff and supported with relevant training.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
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