Choking deaths pose serious threat to the wellbeing of people with disability

Speech Pathology Australia welcomes the Victorian Disability Services Commissioner’s report, “A review of disability service provision to people who have died 2017-18”, tabled in the Victorian Parliament yesterday, 19 December.

While we welcome the Commissioner’s report, it sadly confirms what speech pathologists have been warning for some time now - that unless appropriate plans and supports are in place, deaths associated with choking pose a serious threat to the wellbeing of many Australians with a disability.”

Gaenor Dixon, National President of Speech Pathology Australia

The preliminary cause of 10 of the deaths were recorded as choking on food or aspiration pneumonia – a life-threatening but often avoidable infection caused by inhaling food, fluid, saliva, or vomit into the lungs.

The Disability Services Commissioner identified:

• that in a high number of cases, safe mealtime advice provided by a speech pathologist  was not followed by the disability service, which placed people with disability at significant risk of health complications and death;
• a lack of communication assessments and communication plans in place to support people with a disability to communicate their specific needs and choices and to raise health concerns.

The Victorian Disability Services Commissioner report comes on the heels of the NSW Ombudsman’s most recent report (2014-2017) that confirmed that people with disability who have oral eating and drinking difficulties and live in residential accommodation services are at increased risk from choking, or respiratory illness associated with chronic aspiration.

The NSW Ombudsman previously found that in 2012 and 2013 that the deaths of 239 people with disability in residential care were reviewable. In these cases, the underlying causes of death of people included respiratory diseases (24%) ― mainly pneumonia and aspiration pneumonia ― and external causes, mainly choking on food (7%).

The sad reality is that the most common factors in choking deaths is a lack of clear personalized information about safe eating and drinking for people with disability, and inadequate supervision. People with disability need to have access to speech pathology services, who can work with individuals and also with the service to ensure safe eating and drinking and communication access for all. ”

Gaenor Dixon

Speech pathologists are the professionals who provide assessments and develop mealtime management plans, including advising on changes to the texture of food and fluids to enable safe and effective eating and drinking. People with disability who have problems eating, drinking and swallowing should be assessed by a speech pathologist.

Because adults with cognitive impairment may not be able to communicate difficulties with swallowing, support staff and health care providers need to be alert to the behavioural changes that may indicate a deterioration in their swallowing abilities.

An analysis of the cases reported to the Disability Services Commissioner over the past year indicated 31 per cent of people who were described as being non-verbal, but able to communicate with aids or gestures, were not provided with essential communication plans or aides. Carers and support staff must be aware of their important role in implementing and complying with mealtime management plans and the risks of not doing so.

There were also instances where the recommendations of a speech pathologist regarding the necessary modification to the texture of the person’s food and fluids were not followed. It is clear from the Commissioner’s report that more needs to be done to ensure that people with disability are provided with communication accessible and friendly environments. Only in this way can they communicate their health needs and concerns, especially in relation to feeding and swallowing.

Speech Pathology Australia has been advocating strongly that the NDIA should continue to allow mealtime assessments and supports by a speech pathologist to be included in a participant’s plan.

It’s why we welcome the federal government’s interim decision last week that the NDIS will fund the ongoing assessment and monitoring of mealtime plans for NDIS participants with swallowing difficulties who are not in a hospital or acute care setting.

Any failure by government to fund such mealtime support would endanger the life of Australians with a swallowing disability, as well as limiting their safe and enjoyable participation in the everyday activity of eating and drinking”.

Ms Dixon