Are your goals practical and applicable to your patient’s environment? Does the patient demonstrate adequate follow through with the skills learned in therapy? Have goals been modified to meet the changing needs of the patient? These are some of the questions we ask ourselves as our patient achieves short-term goals and the plan of care is modified to reflect a patient’s increasing independence. At every modification of the plan of care, however, we should ask ourselves, “How will achievement of goals improve overall function? Does the therapy provided have practical applications?” For speech language pathologists (SLPs), they look to ensure receptive and expressive language goals have practical applications that will ensure a patient is safe, functional and independent when therapy ends. Although the practical applications of speech and language therapy may appear obvious, SLPs have a unique opportunity to work with a patient in a variety of situations in a skilled nursing facility. They provide therapy that addresses each patient’s communication needs, and are able to provide therapy in real life situations to ensure good carryover of newly learned skills. Functional situations that enhance communication exchanges include use of a call bell, verbalizing personal preferences and making requests related to care. As a SLP providing speech communication skilled services, ask yourself if you are incorporating the functional, practical aspect of communication into my treatment approaches. Do you take advantage of the opportunities to do so with your patients? When you go to a patient’s room to transport them for treatment, have you tried to do any of these tasks (to support patient’s goals):

• Have the patient call the CNA and ask for help with brushing his/her teeth or request the water pitcher be filled.
• On the way back to therapy, stop at the nurse’s station to have the patient ask nursing when the beauty parlor will be open this week, when the next ice cream social will be or say “good morning,” etc.
• On the way back to therapy, stop at the activities bulletin board to have the patient find and read today’s activities (the actual therapy session may then incorporate goals/tasks that will support success in that activity).
• While still in the patient’s room (before or after the actual session), help the patient to make a phone call to a family member.
• On the way back to therapy, have the patient categorize items, i.e. count how many nurses were seen along the way, name anything blue along the way, etc.

These practical activities can then be shared with family members and caregivers and can be “practiced” with the patient for continued carry over. Almost like developing a home exercise program for speech patients. Sometimes, we are in our routine as therapists to get the patient to the treatment room and work on our formal therapy tasks. For SLPs working on communication and cognition, there are many practical activities that they can incorporate whenever they are with patients which often make more sense to them. Involvement with the patient during these tasks that support their goals allows the SLP to determine carryover of skills. The patient’s responses to these activities would also strengthen the documentation on patient progress. The patient who can communicate effectively with caregivers will have a more positive experience in the health care continuum. Communication during social exchanges enhances engagement with family, caregivers and peers. The purpose of treatment goes beyond the ability to express wants and needs, and provides patients with the ability to alter the environment through effective communication.