Choking Part 2

TK67

My mother, with late stage Alzheimer's has been choking.  She's choked about 7 times in the last three months with us having to give the Heimlich about 5 times to clear her throat. Sometimes this is from solid food and sometimes I can be her own saliva or water.  Took mom to see her neurologist who referred us for swallow test and hospice for palliative care.  We got mom setup on hospice but now she can't have the swallow test because Medicare won't pay for it since she's receiving home health care. 

So, my questions is what is your experience in getting a swallow test?  If we don't have one what do you suggest in what I should/shouldn't be feeding her.  (Mom can still chew and since she doesn't think anything is wrong with her there are some foods she still wants to eat.)  Is there a forum on here that is strictly for choking and what foods should/shouldn't be given? 

Any advice would be appreciated.!

star26

YOU NEED TO GET THE SWALLOW TEST. Hospice can still pay for a speech pathologist to do the evaluation and 1 or 2 follow up visits for the purpose of determining the safest diet and educating you about it. This is what you must insist on. You need to follow thru on the doctor’s orders. There is no one diet recommendation for choking and swallowing problems. What is prescribed for one patient can be the worst advice for your Mom’s situation. Please don’t let this go on further without a swallow evaluation. It’s causing your Mom harm. Besides the obvious physical issues, remember the fear in your Mom’s eyes that you’ve mentioned in past posts.

RobOT

TK, so sorry you're caught up in the hamster wheel of medical money.  I don't know who might pay for the swallow test, but it really is important at this point.  Ask the hospice people about ideas (I doubt they would pay for it if your mom's on palliative care)  or at least see if Medicare will pay for a simple speech evaluation.  That would be better than nothing.  Swallowing is a very technical issue, and I'd be very careful abut applying information from forums and websites unless you know precisely what's going on with her swallow and how to deal with it.  It sounds like she's at home with you.  If there's a social worker available, ask that person about finding avenues for payment on swallow evaluations, also, you could ask a speech therapist about where to get the payment.  Good luck with this, it's so frustrating.

LicketyGlitz

Thanks for posting this, TK. I appreciate getting info on what may be on the horizon for us.

We are just starting down the road with Mom having difficulty swallowing liquids. So far a good solution has been the thickeners in her drinks, which was provided by hospice, but it sounds like you guys are past that.

star26

I’m a SLP and I do swallow evaluations plus 1 or 2 follow up visits for people in hospice. This is a case of the hospice needing to know how to keep the patient comfortable (eating and drinking recommendations and education). Hospice will authorize a couple visits in situations like this one. This is different than PT, OT, and other speech therapy services which are not covered for hospice patients.

Cynbar

You can also take your mother off hospice (known as revoking) in order to get a swallow test and anything else she might need done to make a safe plan for her. I agree with the others, the choking needs to be addressed. Hospice may choose to pay or they may refuse, a lot probably depends on the cost of what is being recommended. There seems to be variations from one hospice agency to another in what they will cover. The problem is not being on home care, it's being on hospice which doesn't generally cover diagnostic tests. But you do have the option of coming off service to pursue this, and then going back on when testing is complete. Ask your nurse or social worker about this option.