Referral Process

In order to refer a resident to our service please complete our referral form. Prior to completing the referral, please consult our dysphagia checklist for case specific guidance and to see whether a referral is appropriate. You may also find it useful to also complete a swallow diary as this can help identify patterns in someone’s difficulties.

The Managing Dysphagia checklist is shown below with resources

Observation/Difficulty	Management suggestion	Outcome and date Include information on changes trialled, and whether problem has resolved or continues. Include date changes were started and reviewed
Aspiration pneumonia or recurrent chest infections (3 or more in the last year)	GP Review Refer to SLT.
Eating and drinking difficulties due to a baseline respiratory condition	Follow Eating and drinking strategies. Offer softer options to reduce chewing effort/amount of time food spends in mouth. Ensure small sips/mouthfuls and encourage breaks between mouthfuls. Refer to SLT if signs of dysphagia are observed.
Chewing Difficulties	Complete oral health check, ensure dentures fit correctly if present. Complete food diary to highlight any patterns in difficulty Follow Managing eating and drinking behaviours that might challenge	Inappropriate to refer to SLT if no signs of dysphagia.
Choking (Complete obstruction of the airway which required back slaps/Heimlich manoeuvre)	Was this a one-off incident? If yes, monitor oral intake closely, provide close supervision. Ensure Eating and drinking strategies are followed. If there are further choking incidents avoid or adapt specific food item that caused choking episode and refer to SLT
Coughing when eating	Follow Eating and drinking strategies, if coughing continues complete a swallowing diary and refer to SLT
Coughing when drinking	Follow Eating and drinking strategies, if coughing continues complete a swallow diary to document frequency and refer to SLT. Do not thicken fluids without SLT assessment.
Drowsiness: not alert enough to eat and drink safely	If this drowsiness is new contact GP for review. Offer oral intake when resident is alert, even if for brief periods	Inappropriate to refer to SLT. Only refer if resident presents with unmanageable swallowing difficulties when alert.
Fast Rate of eating and drink/ cramming	Follow Managing eating and drinking behaviours that might challenge
Food Residue seen in mouth after eating	Follow Eating and drinking strategies. Ensure good oral hygiene.
Medications: difficulty swallowing tablets	Request review by pharmacy or GP. Medication may require modification.	Inappropriate to refer to SLT.
Positioning difficulties: unable to sit in or maintain upright position	Refer to Eating and drinking strategies. Consider a referral to physiotherapy or occupational therapy for positioning advice.
Refusing to eat and drink	Follow Managing eating and drinking behaviours that might challenge. Review oral health, any sores or sources of pain? Alert GP	Inappropriate to refer to SLT if no signs of dysphagia.
Regurgitation of food or fluids or symptoms of reflux in the absence of swallowing difficulties	GP review Follow Oesophageal Dysphagia advice.	Inappropriate to refer to SLT.
Resident is struggling on current diet texture	Under supervision, consider modifying texture of food by one level at a time. E.g. level 7 regular easy chew to level 6 soft and bite sized diet Trial change for 1-2 weeks and document outcome. Document all changes and monitor the resident closely. Ensure Eating and drinking strategies are followed. If difficulties begin to occur on these changes after three months, consider another 1 step change and trial this as previous. If difficulties occur within 3 months of making the initial change, please refer to our service (Only change fluid consistency without SLT assessment if part of the pilot project)	Do not need to refer to SLT if tolerating IDDSI level without difficulty. If further modifications are felt necessary please refer to Adult Speech and Language Therapy Please notify Adult Speech and Language Therapy of the changes to their diet texture so our records can be updated.
Improvement in swallow. Resident has been placed on thickened fluids, is tolerating these well and their general condition has improved	Under supervision, consider modifying fluid consistency one level at a time. E.g. level 1 to level 0, level 2 to level 1 Trial change for 1-2 weeks and document outcome. Document all changes and monitor the resident closely. Ensure Eating and drinking strategies are followed. If difficulties begin to occur on these changes after three months, consider another 1 step change and trial this as previous. If difficulties occur within 3 months of making the initial change, please refer to our service (Only change fluid consistency without SLT assessment if part of the pilot project)	Do not need to refer to SLT if tolerating IDDSI level without difficulty. If further modifications are felt necessary please refer to Adult Speech and Language Therapy Please notify Adult Speech and Language Therapy of the changes to their fluid consistency so our records can be updated.
Saliva Management: Thick saliva and/or dry mouth	Review by GP. Follow Managing Saliva advice.	Inappropriate to refer to SLT.
Saliva Management: excess thin/watery saliva	Review by GP. Follow Managing Saliva advice.
Weight loss due to significant reduction in fluid/food intake	Follow Eating and drinking strategies and Managing eating and drinking behaviours that might challenge Complete MUST score and discuss with GP, then refer to Care Home Support Service if indicated. Refer to SLT if clear signs of dysphagia seen and still present following implementation of advice.
Wet Voice after eating or drinking	Follow Eating and drinking strategies. Prompt to use further swallows to clear. Monitor for signs of aspiration.

Page last reviewed: 23 April, 2025

Oxford Health

Guidance for care homes

Guidance for care homes