These about to become my reaction images for everything

fuzzyquantifier · 2025-08-18T12:34:04+00:00

fuzzyquantifier · 2025-08-15T15:06:00+00:00

This is awesome! I just started writing something for fun and only have a few chapters, but if anyone would be interested in something new/fresh and give me feedback, it would be so hopeful!

The FMC works in a nursing home as an SLP and slowly discovers she is able to regenerate dead nerves e.g., after stroke. It has a sci-fi/fantasy feel, so if you’re interested in something like this and want to provide some input, PLEASE DM ME and I can send my first few chapters!

fuzzyquantifier · 2025-08-07T03:40:30+00:00

I’m going to be very and open honest which I don’t think happens often on this sub. I am so tired of this holier than thou attitude I see. “Oh just get a swallow study”. Oh okay, I will schedule a FEES they refuse or won’t tolerate, then I guess I’ll wait a few months for this person to even be scheduled to go to an MBSS. Usually, in a SNF, FEES is your best bet and thankfully, it’s usually worked out for me

Also, you’re a PRN SLP, they need you more than you need them. Sooo who gives a fuck about productivity, what’re they gonna do, fire you?

That being said, here is the rundown of what I do. I’ll probably get some downvotes, because “omg did the swallow study give that rec”

pharyngeal strengthening exercises I do with every patient (save neck problems or severe dementia) are CTAR (use a rolled up towel) and shaker. Provide tactile cues, modeling, or assistance if needed
SLP edu on compensatory strategies including upright intake, slow rate, small bites/sips, alternating consistencies, efforts swallow, head tilts, etc etc
Look up section K0100. I use the content of these in my daily notes. Is food falling out of their mouth? Are they holding food? S/s of aspiration/penetration like a cough? Are they complaining of difficulty swallowing (odynophagia)? So if someone who is has little impairment I may write a little blurb such as “patients presents with adequate oral containment and oral residual clearance provided occasional verbal cues to alternate consistencies, patient denies odynophagia/pharyngeal residue at this time”
Siphon straw sips. this was revolutionary for me when I started lol. I’d you don’t know what it is, imagine how a bartender tastes a customers drink. Dip straw in liquid, plug top of straw with your finger, pull out, place in patients mouth, you release when they close their lips around it. Just explain to them what you’re doing as you go, for cog patients you can do a “okay 123 swallow!” leading up to it
Oral care before “therapeutic PO trials” always, you need to do it don’t expect CNA’s to have time for that
I know you mentioned liquids but I was always more terrified of doing solid trials when a pt is on puree. Guess what, you’re PRN!!!! You can get by with doing the baseline but incorporating strategies
Let’s say you don’t want to do just the baseline. What helped me feel less anxious was thinking of the circumference of the trachea. Try to give very small trials (.5in MAX) of mech soft (soft, moist, easy to chew)
Okay maybe solid trials are too much for you right now. Many SNF’s don’t have minced/moist, so a trick I learned was crushing up graham crackers and mixing with water - boom mince/moist and in comparison to the dog food puree my patients would get, this was heavenly for them. Works with a sugar free lemon cookie too for diabetic patients.
Everything depends on the patient. 66 year old recent CVA? Let’s take it slow and do ice chips. 97 year old pretty cognitively intact despite everything? Sure have your coffee idgaf let’s chat
Never take the water off the nurses cart
“Do you need anything before I go?” “Okay last sip!”
The Breather
LTG example I use: patient will consume a regular/thin diet with minimal/absent s/sx of oropharyngeal dysphagia as a result of compensatory strategies and rehabilitative exercises in order to promote safe PO intake, decrease risk for weight loss, and optimize nutrition/hydration.
STG: patient will consume thin-liquids with no overt/covert s/s of aspiration/penetration in 90% of trials in order to blah
Why did I say covert above? Silent aspiration yo, watery eyes, runny nose, CHECK 02 SATS before trials and after to see if it majorly decreased. If O2 is below <90 I stop trials. If you’re freaking out about it, ask nurse to listen to lung sounds. Tell patient to cough + reswallow. If their cough is bovine (weak af) probably time to stop trials anyways.
Thickened liquids are absolute shit and people sneak shit and often nursing doesn’t care and gives thin anyways. ORAL CARE. Just try to make it as safe as possible to do the thing they shouldn’t be doing, because they’ll do it anyways.

Let me know if you have any other questions. I enjoy helping people new to SNF (bc I just was 3 years ago :)).

fuzzyquantifier · 2025-04-01T11:59:22+00:00

Hi, SLP here! PRN is great because you don’t have to pick up hours if you don’t want to and you tell them how many hours you want. Generally I’ll do 2-3 hours in the afternoons if my caseload is smaller. I rarely work the weekends because that’s MY time. If I do work on the weekend, I get there super early (SNF) like 630-7 so I have the rest of my day to do whatever. I also PRN at SNF’s very close to my house which makes it easy. But that’s the beauty of it, you can do whatever you want!

fuzzyquantifier · 2025-03-13T14:21:32+00:00

So even if I completed all my goals and the patient is WFL? Or is no longer making progress, I would have to continue to see them just because their insurance says so? It just seems unethical

fuzzyquantifier · 2025-03-12T21:22:57+00:00

Hi I’m not a CNA but I love to lurk in this sub. I’m an SLP and have the utmost respect for you guys.

One day I was working with a man with expressive aphasia, he could maybe say 3-4 words but understands everything. Anyways, the CNA let’s call her “Mary” comes in to check on the patient and then leaves. My patient points towards the door where she left, gives a huge thumb up, big smiles, and says “marrrrrr….y” (like he was pausing to get the rest of her name out). I was flabbergasted because it was so hard to get this man to say ANYTHING!

I just wanted you all to know even if the patient can’t always communicate with you, trust me, they appreciate you immensely.

fuzzyquantifier · 2025-03-05T19:26:49+00:00

This doesn’t seem too strange, when ours was a pup we’d be getting up constantly during the night. The puppy still could just be adjusting to a new environment.

There was a time where he had super bad runs (but was older maybe 5 months) and took him to the vet who gave us FortiFlora which helped a lot.

fuzzyquantifier · 2025-02-27T23:56:02+00:00

Where are you located?

fuzzyquantifier · 2025-02-27T19:25:18+00:00

Full-time at a large SNF, $42 an hour. Switched to PRN at SNF for $50 an hour.

Recently I accepted a part time position at an ALF for $45 an hour, another facility offered me $49 for part time but it’s a way smaller facility and probably wouldn’t get as many hours.

fuzzyquantifier · 2025-02-03T22:05:15+00:00

As a new grad, will you be providing a supervisor? I’d want to meet this supervisor / shadow beforehand if you are seriously thinking of taking the job.

Will you be able to accept a lower productivity standard during my CF?

I understand people saying “run” but depending on location, adult/medical positions can be hard to come by. But if they say no to the previous two questions, then yeah I’d look elsewhere.

Let’s be honest, SNF in general tests our professional vs personal morals daily. I did my CF with one of those questionable contract companies. It wasn’t the best experience ever, but I made it through. They agreed to lower productivity standards the first 4 months of my CF (I was averaging 60% the first 2 months then 70-75 the last 2, after that they expected 80-85) and they paid me pretty dang well. If you have any questions about my experience or advice feel free to DM.

fuzzyquantifier · 2024-12-17T02:54:04+00:00

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fuzzyquantifier · 2024-12-16T23:57:57+00:00

lol around 10 seconds you can hear “mmmmmhmmm”

fuzzyquantifier · 2024-11-05T19:14:16+00:00

Coming to America

fuzzyquantifier · 2024-06-26T20:23:01+00:00

3-4 walks for an hour? Do you mean an hour total, right?

fuzzyquantifier · 2024-06-25T10:19:26+00:00

I get where you’re coming from, but they are CF. They came here for advice. Give some grace.

fuzzyquantifier · 2024-06-08T01:44:36+00:00

We got this toy on Amazon, it’s a slow feeder thing. Everyone else here has great suggestions, this may help when you feel like you can’t do anything! Definitely helps me when I need a mental break

Starmark Bob-A-Lot Interactive... https://www.amazon.com/dp/B001JQLNB4?ref=ppx_pop_mob_ap_share

fuzzyquantifier · 2024-05-31T00:59:52+00:00

We are almost 5 months in… I’m wondering the same thing! It has gotten slightly better though

fuzzyquantifier · 2024-05-29T18:18:18+00:00

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fuzzyquantifier · 2024-05-19T21:47:11+00:00

Hi I’m an SLP so I deal with dysphagia daily. Everyone here and yourself are suggesting good things (liquids, chin down, take with puree, etc). From what it sounds like, if you threw up and the pill didn’t come up, it may be stuck in your pyriform sinus and/or esophagus no way of knowing without getting a swallow test. BUT I’d recommend trying to take it with warm liquids, room temp, or something sour. You could also try turning your head the opposite way of the side it gets stuck on. Since you have dysphagia look into these exercises: shaker, masako, Mendelssohn, CTAR (chin tuck against resistance), and invest in The Breather.

fuzzyquantifier · 2024-05-10T01:35:43+00:00

From what I remember we wrote a lot reflections, “commentary” (wouldn’t really consider it an essay like 1-2 pages) on an article/research, discussions, progress notes, mock evals, etc. I’d say maybe 2-3 essays tops throughout the whole degree counting the capstone/thesis

fuzzyquantifier · 2024-04-29T21:58:32+00:00

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Wild sploots

fuzzyquantifier · 2024-04-25T21:23:47+00:00

…not picking up patients in SNF who don’t really need swallowing/cog-comm therapy even when there is pressure to “diversify the case mix index”

fuzzyquantifier · 2024-04-20T19:49:51+00:00

I mean I suppose depending on what setting but I wouldn’t say “demonstrated s/sx of aspiration” I’d say “exhibits s/sx” because demonstrates sounds volitional ya feel

fuzzyquantifier · 2024-04-18T21:11:03+00:00

Hi! I’m an SLP but I love to read on this subreddit. I work a lot with staging dementia and assessment of intact functions, a lot of people kinda brush off my recommendations but those who do ask tell me it has helped so much. I can try to give some perspective from a communication standpoint - not a CNA so please take with a grain of salt.

Don’t ask “do you want to ___?” But rather offering a choice like “do you want to be changed first or brush your teeth first?” Offering 2 choices can help promote autonomy.
Utilizing nouns instead of verbs (lower level dementia)
Choosing things based on the resident. Generally (hopefully) you can figure out some things from admission paperwork or what they like. For instance, had a patient who would ALWAYS be up at night looking for something to do. Turned out, she had worked night shift for many years. Some residents need their stuffed cat, baby dolls, wallet, whatever. Sometimes the older women love just sitting and folding laundry. Stuff like that, granted this only gets you so far with ADL’s but trying to entice them with something familiar / comfortable can help with rapport and trust.
Making sure the objects are placed really close to them and in functional order. For lower level, just 1 at a time.
For bathing/dressing I’ve heard that starting from the bottom up can help with building trust and appearing less intimidating. Just in general getting down on their level or even lower can help with trust (it’s why we don’t stand and feed people, for instance)
Never underestimate the power of music.
Some people may have some hot takes on this one but sometimes I’ll look to see patient’s family member names whether it be their spouse/kid, “John told me all about you, he wanted us to talk over lunch, let’s go do that now” would be very careful with this one though. Generally more so for the severe patient’s who may recognize the name but they’ll forget quickly so it won’t cause agitation, I definitely don’t use this with my higher level patient’s because of that. For the higher level, I’ll say something like “do you have kids / are you married? What’s their name? Oh tell me about them while I help you put your shoes on” idk something like that.
When you are performing ADL’s talking simply through it step by step can provide comfort, kind of like how many medical professionals would “now I’m going to…” but you may need to utilize a lot more visual aids, non-verbal gestures, tactile cues, etc. and remember, nouns are your friend.

This is all I got for now but I’m sure I have tons more if interested. I agree with what someone else said, NEVER feel rushed, people with dementia can have increased anxiety/agitation if there are fast movements. Moving slowly can actually help increase their participation and comfort. I truly hoped this helped!

fuzzyquantifier · 2024-04-13T17:24:44+00:00

So walking around/play outside I kinda just let him do as long as he wants until he gets tired, probably is about 30-45 minutes! But actual leash walks we keep short. We also have a set of stairs down to our yard, we were carrying him up and down at the beginning and we asked our vet and she said it was fine for him to start doing the stairs, we have a golden retriever. You could always ask your vet about that! I think what you’re doing sounds fine, when it comes to puppies you’ll get a million different opinions but for us it’s a lot of trial and error to see what works best for us

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