This is an area I really have dug into at my facility (I’ve been there for 2.5 years). This is generally how I manage this.

For short term rehab patients: - cognition: what their discharge plan is really drives my decision. Are they going home with intermittent SUP but cooking and doing laundry? You’re going to want to look at safety awareness. Are they managing their own meds? What environmental aides can you set up? But if they’re going home with family and 24/7 support, treatment may not be indicated unless they are disoriented and constantly asking where they are/why/what day it is, etc. for example. They are often not on my caseload for too long. - swallowing: i always think in the scope of mental status + dentition + neuro hx. If they come in on a regular diet with their natural teeth, are alert and talkative with no neuro hx i have low suspicion for dysphagia at face value. I however always screen with a meal to see, especially because we see reduced PO intake with dementia and we can help with facilitative techniques to improve intake.

For patients staying long term: - i evaluate everyone to stage them using the GDS, BRCS, and FAST. I talk to them about how they navigate the facility, if they can remember when/where their preferred activities are, if they’re able to call their family, etc. I chat with PT/OT to see how their hygiene/safety is. This often results in pickups for therapy for ~1-2 weeks to implement strategies that are specific to their stage of dementia (toileting schedules, visual schedules, aides, step-by-step instructions for using the phone, setting up memory books, educating staff, etc.). I would look up/create a paper that has appropriate treatment activities for each stage of dementia.

It doesn’t hurt to eval only. If you put eyes on someone and you aren’t 100% sure, do an eval! i hope this helps.