Read on to find out more about swallowing assessments and Mealtime Management Plans - also called Oral Eating and Drinking Care Plans - in the NDIS, when do I need to get one, and what do I do to get one
The history of Mealtime Management Plans and Oral Eating and Drinking Care Plans within the NDIS
Mealtime management plans are not new within the NDIS. They have been around since before the NDIS started. They may also be called Oral Eating and Drinking Care Plans (OECDP).
Mealtime Management Plans migrated over to the NDIS from the disability sector when the disability sector was run by government funded organisations rather than the free market of service providers that operate today. They are essentially swallowing recommendations by a Speech Pathologist - for either a child or an adult.
Why Are Mealtime Management Plans and Oral Eating and Drinking Care Plans So Important?
The reason why they have come into prominence is because from November 2021, the NDIS wanted to introduce more care around swallowing issues and how organisations respond to swallowing issues in people with disabilities. This was born out of the Disability Services Commissioner investigations into the number and types of deaths of people with disabilities in care. You can read about the Disability Services Commissioner's 2018/2019 report here. Key issues they found relative to mealtime management plans included service issues around managing choking and aspiration risks.
Additionally, the NDIS in their report "Scoping review of causes and contributors to deaths of people with disability in Australia", in relation to respiratory deaths (19% of deaths) within the disability population concluded that:
there was a lack of comprehensive nutrition and swallowing assessments for at-risk groups
safe mealtime guidelines were not consistently being adhered to due to lack of staff knowledge and/or understaffing
high rates of psychotropic prescriptions and polypharmacy, (were) increasing (the) risk of impaired swallowing function, sedation and hypersalivation
The statistics related to swallowing difficulties and the disability sector
More statistics, gathered by the University of NSW in preparation for the NDIS report found that in NSW:
"most of the people in disability services who died in 2014-2017 required assistance with meals, associated with swallowing difficulties, eating problems, or both. None of the assisted boarding house residents who died required this assistance". Of the people in disability services who died in 2014-2017:
54 (11%) relied on enteral nutrition (tube feeding), primarily via a percutaneous endoscopic gastrostomy (PEG) tube
The majority (85%) had seen a dietitian in the year before they died
Two thirds (65%) had swallowing difficulties
The majority (87%) had seen a speech pathologist and/or attended a dysphagia clinic in the year before they died
Just over half (51%) had eating and drinking mealtime behaviours, such as swallowing without chewing, eating too quickly, overfilling their mouth, and compulsive behaviour around food. (Reference)
Furthermore, a recent study that examined the deaths of 3 Australians and 1 Canadian in residential care that died from choking showed that the deaths were preventable:
'The study found that deaths linked to dysphagia are due to services not providing the type of food texture recommended for the person, failing to document difficulties or make referrals to health professionals, failing to read the person’s mealtime management plans, or failing to provide enough supervision during the meal to assist, or a combination of these issues". (Reference)
Given the above information the importance of having a Mealtime Management Plan/Oral Eating and Drinking Care Plan regularly updated and in place, where appropriate, cannot be over emphasised. They are legal documents related to client care and need to be treated as such.
What does a Mealtime Management Plan look like?
Mealtime management plans can take various forms, depending on the provider who completes them. They will always be completed by a Speech Pathologist as a Speech Pathologist are the only Health Professionals qualified to assess dysphagia.
They may come in a report form or a checklist form. They may have associated guidelines with them such as what level modified diet the client requires and whether thickened fluids are required and what level. Those guidelines should always explain how to achieve the right textured meals and fluids for the client.
If you have not received any guidelines regarding the fluid and food textures, you can review the International Dysphagia Diet Standard Initiative here and download the appropriate guidelines given to you in the Speech Pathologists recommendation.
Plans may include any or all of the following:
texture and fluid recommendations
seating positions
supervision guidelines for supporting the client during mealtimes
best way for the client to take medications
cutlery if special cutlery is required
drinking utensils if a special cup is required or favoured by the client
maneuvers to help the client during swallowing
recommendations regarding size or amount of fluids or food that can be taken at one time
information regarding oral hygiene practices
suggested review date or annual review date (plans need to be kept updated)pciture
picture of the client themselves or foods for the clients (not always)
A plan will always be signed by the Speech Pathologist and should have the date of the assessment on it. Contrary to what the NDIS states, a Mealtime Management Plan will not necessarily have information from a dietitian on it. However, a dietitian, if the client has seen one, will usually have their own template of recommendations and that information should be used in conjunction with/alongside the Mealtime Management Plan. If you have a Mealtime Management Plan available, you should always show this to the client's dietitian so they can incorporate the recommendations into their own assessments.
How do I know if I need to get a Mealtime Management Plan completed and how do I get one?
So now you know why Mealtime Management Plans are important and what might be included in one. How do you know when you need to get one and what do you need to do to get one?
Swallow training is the key to knowing when you need to get a plan completed
First of all, if you or your organisation have never received any training about swallowing difficulties, you should consider completing the NDIS training available from the commission portal. You need to register to complete the training but it is free and it will give you all the information you need to know about swallowing difficulties and best practice within the NDIS. You can also read the dyphagia alert put out by the NDIS and/or watch the video. Whilst there, also read about the practice alert for medications that are associated with dysphagia
Images: 1 -Dysphagia Practice Alert-NDIS; 2 - Cartoon graphic of head/neck with swallow problem; 3 Medicines/Dysphagia alert - NDIS
In addition to the above information you can read further about swallowing difficulties from the Speech Pathology Australia information sheet available here:
Getting one completed
To get a Mealtime Management Plan or Oral Eating and Drinking Care Plan completed within the NDIS, you can do any of the following:
let your client's Support Coordinator know that one is required as funding will come from the client's NDIS monies. This also applies if the plan you already have requires an update
you can also give the name of the previous speech therapist who completed the plan and this can be followed up by the Support Coordinator
you can contact the Speech Therapist directly who completed the last plan and they will then make arrangements to get the plan updated
family members or recognised support staff who organise services on behalf of a client, can search for an appropriate Speech Therapy service with experience in dysphagia management to get a plan completed/updated
if your client has no NDIS funds available, you will need to go to the GP to get a Team Care Arrangement done. A medicare rebate can then be applied but it is likely that the client will have to pay a gap fee as swallowing assessments are not generally bulk billed
Further information
If you want to find out further information about Mealtime Management Plans, Oral Eating and Drinking Care Plans or Dysphagia/swallowing assessments - you can contact our service by going to the contacts page on our website.
Ensure you do the best for your client by getting the appropriate service to support their needs!!
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