CH230-Supporting People with Swallowing Difficulties Policy

Registration Number: {{org_field_registration_no}}

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, specifically Regulation 12 (Safe Care and Treatment), Regulation 14 (Meeting Nutritional and Hydration Needs), Regulation 9 (Person-Centred Care), and Regulation 10 (Dignity and Respect).

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.

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. 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.

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.

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. 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.

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.

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. 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.

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}}
Copyright © {{current_year}} – {{org_field_name}}. All rights reserved.