Using FEES to Assess Aspiration in the Geriatric Population

 Treating dysphagia in the skilled nursing area requires a highly trained individual with a balance of medical expertise, compassion and an understanding of cultural norms.  The job can be incredibly demanding while at the same time as equally rewarding.  As a Speech Language Pathologist, I know that it is incredibly important to use every tool available to me to ensure I arrive at the appropriate diet and liquid consistency possible for the patient. We have been using Flexible Endoscopic Evaluation of the Swallow (FEES) for over 15 years in New York providing the Skilled Nursing Facilities we serve with onsite evaluations that enable myself and other clinicians the opportunity to literally see if a resident is tolerating his or her foods and fluids, if there are compensatory strategies that ensure safe toleration of a diet and, hopefully, rule out any evidence of silent aspiration.  When we first began, there were some legitimate questions and concerns raised by facility owners and administrators who need to see the value in performing these tests in their facilities.   Surprisingly, we still run across some facilities that need to see the value in FEES even as it has been generally accepted testing procedure throughout the industry.   Administrators and owners often need to be reminded that neurogenic dysphagia, one of the most frequent and prognostically relevant neurological deficits in a variety of disorders, such as stroke and Parkinsonism is often difficult to identify and measure without an objective study.  It allows evaluation of the efficacy and safety of swallowing, determination of appropriate feeding strategies and assessment of the efficacy of different swallowing maneuvers. The literature also indicates that FEES is a safe and well-tolerated procedure (Dziewas, et. al. 2016) FEES can be performed in the facility, at bedside or wherever the resident typically eats, and is performed with no exposure to radiation unlike a modified barium swallow study.   In addition, the test is reimbursable under Medicare Part B in a SNF on a UB-04 as well as most HMO providers.     Got questions about Speech Therapy, FEES testing, Skilled Nursing Facility Rehab, RCS-1 or maybe something else?  We'd love to help!   Message us in the space below! Dziewas, R., Glahn, J., Helfer, C., Ickenstein, G., Keller, J., Ledl, C., … Busse, O. (2016). Flexible endoscopic evaluation of swallowing (FEES) for neurogenic dysphagia: training curriculum of the German Society of Neurology and the German stroke society. BMC Medical Education, 16, 70. http://doi.org/10.1186/s12909-016-0587-3