Restoring Dignity and Quality of Life at Mealtime-Guest Post

By Howard Rosenberg, Director of Dining Services at Amsterdam Nursing Home

Howard Rosenberg is the Director of Dining Services at Amsterdam Nursing Home, a 409-bed long-term care residence in New York City.

It’s no secret that adults with dysphagia are at higher risk of malnutrition and dehydration than most healthy adults. Transitioning from “regular” meals to thickened and pureed food is hard and met with resistance. Yet, overcoming the challenge is essential to both the individual and his or her caregivers.

After experiencing so many mealtime issues, my staff conducted an eight-week study of 16 residents with dysphagia. We observed that residents tried to open packages rather than wait for assistance, drank thin beverages before they were thickened, or refused them altogether after watching them be thickened.

Change was necessary – but it didn’t have to be drastic to make a difference. Our staff knew we needed to:

  • Increase fluid intake of residents with swallowing difficulties
  • Restore resident dignity, quality of life and desire to enjoy mealtime
  • Re-establish a personal level of independence during meal service

In order to do so, we made the following changes, which can easily be adopted in the home setting as well:

  • Thickening residents’ beverages before serving them, using a stable pre-thickened water or juice– available at many pharmacies (ask your pharmacist) – as the base of each recipe, which eliminates the need to thicken liquids in front of the residents.
  • Pouring all beverages below the top of the cup, e.g. 4 oz. of juice in a 7 oz. cup, to reduce spilling caused by shaky hands, thereby boosting residents’ confidence in serving themselves.
  • Serving pre-thickened ready to eat soups and a variety of flavored broths prepared with a pre-thickened water.

We also offered a variety of pre-thickened beverage flavors throughout the day – served with snacks, at the bedside and when taking medications.

After these adjustments, we’ve found that fewer seniors have requested help during each meal, and that residents’ fluid intake has increased significantly.

The key to our successful hydration program at Amsterdam Nursing Home has been using a pre thickened crystal clear unflavored nectar or honey water (in our case we use Thick-It® AquaCare H2O®). This product is the primary base for all the flavorful drinks and soups we serve our residents. We are also able to fulfill specific beverage requests, hot or cold, including ice cubes with this product. Using pre-thickened waters means no mixing or measuring thickeners, which we believe has a direct impact on the appeal of the drink, the independence it gives the resident to serve themselves, and subsequent consumption.

The program, although requiring some additional staff time for mixing the beverages, has actually saved us money due to the reduced waste per resident.

Residents have given positive feedback on the program – through their comments and overall moods – and are more engaged during mealtime.

Whether you’re a long-term care employee, a speech-language pathologist or caring for someone with dysphagia at home, these small changes can make mealtime a safer and more enjoyable experience for your patients or loved ones.

Give Away


I am very grateful for the VERY generous donations to give-away to celebrate 5 years of blogging!!

So, how exactly is this going to work?  

My blog all started with the ASHA convention 2010, so that’s where 5 years will start!!  Throughout the convention November 12-14, 2015 I will be posting on Facebook and Twitter.  This will ONLY happen on the Dysphagia Ramblings page, so make sure you like the page.  The posts will also appear on Dysphagia Ramblings Twitter.  Answer each post for a chance to win!  

The prize will be announced with each post.  Names will be raffled randomly and each person will have one chance for each prize!  

The list of prizes you ask?

  • Internal Branch Superior Laryngeal Nerve Course from Dr. Eric Blicker
  • ISO-SED device 
  • TheraSip Swallowing Trainer
  • CTAR Ball from TheraSip
  • Tongue Press from TheraSip
  • TheraMist from TheraSip
  • A TheraPACK from TheraSip (All 4 of the above!!!)
  • A One Year Subscription to Speech
  • A One Year Subscription to MedBridge
  • $100 Voucher to any live course from CIAO Seminars
  • Codes to the new app from Tactus Therapy:  Dysphagia Therapy
  • Codes to Dysphagia2Go from SmartyEars
  • Book from Northern Speech Services
  • Online Course from Northern Speech Services

WOW!!!  I am beyond excited!!!  How about you??

Make sure to LIKE the Dysphagia Ramblings Facebook page and follow @dysphagiarmblng on Twitter to enter to win these AMAZING prizes!!!

ASHA 2015 and Blog Give-Aways Just Around the Corner!

IMG_4471 IMG_4472

It’s that time of the year, the leaves are turning and falling, it’s still dark when my alarm goes off and my phone is reminding me that my flight to Denver is in 20 days!!!  

Every year is the same anticipation.  Social media starts flaring up with talk of the upcoming ASHA convention and I start counting down the days until I see my friends again.  This year is no exception!!

What is different for me this year though is my Blogiversary.  Five years ago, during the ASHA convention, I started blogging and became active on social media.  I have made so many new friends since that time!!  

In honor of FIVE years of blogging I’m having some amazing give-aways!!!  I am extremely humbled and honored by the generosity of donations for this give-away!!!  Keep watching for more details coming in the next week on the specifics of the give-away!!  Some of the items:

  • ISO-SED Device
  • TheraSip Goodies
  • Northern Speech Services Goodies
  • Internal Branch Superior Laryngeal Nerve course from Dr. Blicker at CEU Allied Health
  • $100 voucher for a live course from CIAO Seminars
  • Free codes for a new, exciting dysphagia app
  • Free code for Dysphagia2Go
  • EMST 150
  • More in the works!!

ASHA week will be a busy and FULL week with friends, colleagues, sessions, exhibits and give-aways, not to mention blogging!!!  As always, I will be live-tweeting courses I attend.  

What courses will I be attending this year?

Wednesday Night will be the Meet the Master’s Program:  Radiological Procedures, Evaluating the Upper and Lower Digestive Systems from Infancy to Senescence.

Thursday’s Lineup:

  • #1040 What’s Wrong with My Patient? Esophageal Disorders and the Effects of Human Aging on Swallowing-James Coyle
  • #1125 Best Practices in Head and Neck Cancer:  Implementing Speech Pathology Pathways in the Multidisciplinary Team-Messing, Hutcheson, Blair
  • #1177 Dysphagia Therapy:  Are There Guidelines in Prescribing Exercise-Based Treatments?-Ruzicka and Doyle
  • #1214 Skill vs. Strength Training in the Management of Dysphagia:  The Great Debate-McCoy, Humbert, Plowman

Friday’s Lineup:

  • #1341 Neuroplasticity & Dysphagia Rehabilitation:  How to Connect the Dots-Martin and Malandraki
  • #1382 Intervention Planning for Dysphagia Based on Objective Studies and Reports:  Translating Results into Practice-Salmon and Maharay
  • #1473 Can We Use “Compensatory Strategies” to Challenge Swallowing Impairments?-Humbert, Vose, Sunday
  • #1519 Gauging the Aging Swallowing:  Clinical Considerations for the Speech-Language Patholgoist-Rinki and Yvette
  • #5639 Comparing Swallowing Efficiency by Gender, Bolus Consistency and Task-Palmer, Bolognone, Harrington, Graville


  • #1641 Rehabilitative Training Using Exercise: Blending Muscle Conditioning and Motor Learning Aspects into Therapy-Carnaby, Ruddy, Crary
  • #1688 Strengthening Swallowing and/or Dysphagia Intervention:  Three Mythbusters!-Robbins, Rogus-Pulia, Rusche
  • #1782 Complex Dysphagia Cases in the Adult Acute Care Setting-Kizner, Deane, Kutch
  • #1828 Efficacy of Adjunctive Modalities in Dysphagia Treatment-Lazaras, Troche, Langmore

Now it’s time to make my packing list!  

  • Comfy clothes (I’m not presenting and have no intention of dressing up!  Long sessions and much learning calls for comfort!)
  • Comfy shoes (There’s A LOT of walking!)
  • Light bag (To carry my iPad and chargers.  Nothing heavy because it is a long day!)
  • Hygiene supplies (Shampoo, soap, the works.  Don’t forget the deodorant…..long days!!)
  • Sweater or light jacket (Some rooms are hot and some rooms are cold.)
  • My list of sessions.  (There is nothing worse than arriving at the conference and having no clue where to go.  There are computers to  create and print your agenda, however they can be very crowded.)
  • Portable charger (I use a New Trent which will charge my phone and iPad fully at least once if not more.)
  • Power strip or multi USB charger.  (Let’s face it, hotels often don’t have enough outlets for all your electronics and if you have a roommate or 3, you will definitely need the extra charging space.  
  • A small first-aid kit.  (You never know when a headache will come on or you need a band aid for blisters from SO MUCH walking!)
  • An open mind.  (There are so many sessions to attend and so much information to learn!!  Be ready to learn, not only in your sessions but in the exhibit hall.)
  • Pajamas (There is very little time to sleep, however it’s nice to be comfy during those brief periods of rest!)

I hope to see you in Denver!

Day 2 Critical Thinking in Dysphagia Management

What drives your assessment and therapy plans?  

Thank about this.

Are you that person that is in and out in 15 minutes, quick chart check to look at diagnosis, quick med check, look at oral structures and range, trial some food and done?

What about your therapy?  What does that look like?  Are you handing your patient a list of oral motor exercises to complete 10 times each?  Are you watching your patient eat in the dining room?  Are you hooking the patient up to E-Stim and letting them sit with the stim on their neck?

Are you an SLP that maybe thinks you’ve learned all you ever can about dysphagia?  

As a dysphagia specialist, you will NEVER learn everything about dysphagia.  There is always room to grow.  There is always a new course to attend.  There is always that person that is new to the field.  

Sometimes, I’m guilty of attending a course and thinking, yea, what exactly are you going to teach me?  

I went into this Critical Thinking course with high expectations and my expectations were met and exceeded.  This course was FABULOUS!!  It was thought-provoking and very relevant to everyday work. Dr. Humbert and Dr. Plowman are very entertaining and are great at involving participants.

If I had to sum up my experience with this course and tell everyone in one sentence what this course is about it would be this.  Investigate the why of the swallowing difficulties throughout the evaluation and treatment.  The why is the most important part.  If you can justify why there is a problem, you can determine the most appropriate treatment plan.  If you understand the why of your treatment plan, why you chose the techniques you chose and why the patient needs to work on each techinque, you can justify your therapy.  

There will soon be a chirp story created with the tweets from this workshop! 

The best news………..

This workshop will happen AGAIN!!  Keep an eye out for news!!!

Day 1 of Critical Thinking

I survived the first day of the Critical Thinking in Dysphagia Management workshop!!  

I’ve become extremely conscientious of the continuing education coursese I attend.  Most of these courses cost quite a bit and I’m looking to maximize my learning.  I enjoy continuing education.  The day that I feel like I know everything about dysphagia is the day that I need to throw in the towel.  I don’t think I’ll ever know everything about dysphagia.  

The Critical Thinking in Dysphagia Management course is not only refreshing, but exciting.  The presenters are fabulous!!  Ianessa Humbert and Emily Plowman have put together a thought-provoking and entertaining course for sure!

If you want to check out the live Tweets look at #CTDM or follow @dysphagiarmblng.  

Dr. Humbert always presents a challange to clinicians to use problem solve and use their knowloedge to figure out the swallowing mechanism.  She’s always asking why, why, why.  When I step back and take a look, I realize, she is making me find my own answer.  She doesn’t just stand up and present so much information I can’t possibly comprehend it all, she is actually making everyone in the audience think and participate!

The day started with a quote from Rosenbek from 1995 when he stated that the aphasia world had an alarm sound which resulted in an increase in efficacy data.  There is no such alarm for dysphagia.  

Dr. Humbert is full of wonderful analogies that very much compliment learning.  Several are posted on Twitter.  

One of her main points was that we need to advocate.  One of the most important pieces of our job is to complete a great evaluation.  We owe it to our patients to be thorough, to assess the anatomy and physiology and to assess the possible treatment strategies.

One of the greatest parts of today was the live MBSS which was broadcast via Periscope.  Using a remote device, we were all able to push button a, b, c, d, e given choices for each letter for the next texture/strategy/maneuver to try.  It was such a great participation activity.

Dr. Plowman discussed neural plasticity, cortical representation and compensation vs. exercise.  

The last part of the workshop was spent looking at various MBSS and determining normal vs. abnormal in determining laryngeal closure, hyoid burst, etc.

Live-tweeting will resume tomorrow with a folow-up blog post!!

New and Exciting!!

Expect some new and exciting things from Dysphagia Ramblings!!!

I have been playing around with the blog over the last year to see what everyone wants and what they don’t!  It seems that EVERYONE loves the research!!!

Over the next few months and this is absolutely a work in progress, Dysphagia Ramblings will begin adding some exciting research links.

Don’t forget the 5 year Blogiversary!!!  Follow the blog, Facebook page and Twitter account for some exciting prize give-aways!!

Also, follow my blog and Twitter account (@dysphagiarmblng) for live-tweeting/blogging from Dr. Humbert’s upcoming live course!!  If you are interested in learning about Critical Thinking in Dysphagia Management but can’t make it to Baltimore in 2 weeks for the live course, watch my Twitter feed for live Tweets and summary of the course each night on this blog!!

Thanks to Dr. Humbert for this amazing experience and for letting me live-blog the course!!