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The Long-Term Care Companion
Ages: Adults   Grades: Adults

Efficiently plan treatment for clients in long-term care with this resource of goals and functional activities.   


  • Develop effective long- and short-term goals for clients with aphasia, apraxia, dysarthria, dysphagia, and dementia
  • Provide functional, goal-directed tasks in therapy
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** This is a Cloud E-Book that is accessible from any device with Internet access. .

This hierarchy of goals and activities is a framework for the management of a wide variety of clients in residential-type settings.  The book is divided into these units and sub units: 

  • Aphasia—Auditory Comprehension, Verbal Expression, Global Aphasia, and Right Hemisphere Dysfunction
  • Apraxia—Mild, Moderate, and Severe Apraxia of Speech
  • Dysarthria—Oral Motor Exercises, Articulatory Precision, Speech Rate, and Prosody
  • Dysphagia—Disorders of Mastication, Preparatory Phase, Oral Phase, Pharyngeal Phase, and Dysphagia Arising From Dementing Diseases
  • Cognitive-Linguistic—Cognitive Functions/Communication (i.e., orientation and memory), Activities of Daily Living, Time Use, Social Skills, and Emotions/Behavior

Each unit has a long-term goal.  The sub units are further divided by short-term goals, giving you a progression of treatment.  Each short-term goal is paired with a realistic activity for geriatric clients.  Most of the activities use materials found in the patient's room or facility, making them easy to set-up and functional.  Activities for family and caregivers are included.   

Copyright © 2003

107 pages
  • ASHA (2005) states that speech-language pathologists have the unique educational background to screen, evaluate, and treat swallowing and cognitive-communication disorders associated with dementia-based communication disorders.
  • In a group of stroke patients, 40% of the older geriatric group (ages 85 years plus) showed improvement in Functional Independence Measure™ (FIM) in comparison to 53% of the younger geriatric group (ages 75-84 years old).  Thus, though the older geriatric group improved less overall than the younger geriatric group, this study shows that age should not be the sole reason to exclude patients from benefiting from rehabilitation programs (Lieberman & Lieberman, 2005).
  • A multidisciplinary stroke team approach in rehabilitation benefited patients regardless of age, stroke severity, or gender.  However, the greater the severity of a stroke, the longer skilled therapy may be needed.  This may include a variety of therapy sources, such as acute comprehensive rehabilitation, outpatient, home health, or a skilled nursing facility (Dewey, Sherry, & Collier, 2007).
  • Individuals with strokes can still improve their functional communication and swallowing skills six months after initial onset.  Patients under 60 years of age who had a high level of responsiveness/alertness had the highest level of functional gain during the chronic period of rehabilitation in a study by Carod-Artal, Medeiros, Horan, & Braga (2005).

The Long-Term Care Companion incorporates these principles and is also based on expert professional practice.


American Speech-Language-Hearing Association (ASHA). (2005). The roles of speech-language pathologists working with individuals with dementia-based communication disorders: Position statement. Retrieved August 10, 2009, from

Carod-Artal, F.J., Medeiros, M.S.M., Horan, T.A., & Braga, L.W. (2005). Predictive factors of functional gain in long-term stroke survivors admitted to a rehabilitation programme. Brain Injury, 19(9), 667-673.

Dewey, H.M., Sherry, L.J., & Collier, J.M. (2007). Stroke rehabilitation 2007: What should it be? International Journal of Stroke, 2, 191-200.

Lieberman, D., & Lieberman, D. (2005). Rehabilitation following stroke in patients aged 85 and above. Journal of Rehabilitation Research & Development, 42(1), 47-53.


Lisa Arnold


Lisa Arnold, M.Ed., CCC-SLP, received her undergraduate and graduate training at the University of Georgia, Athens, Georgia.  She has worked in a variety of settings including a community speech and hearing center, acute and rehab hospitals, public school systems, private practice, and home health care agencies.  She is currently a full-time speech-language pathologist at ManorCare Health Services in Decatur, Georgia.  Lisa has over ten years experience in the long-term care setting.

Lisa is also the author of WALC 5 Workbook of Activities for Language and Cognition (formerly The Source for Neuro Rehab) and The Source for Aphasia Therapy.


Throughout my practice, I have witnessed a great evolution in speech-language pathology services in long-term care.  This previously underserved setting is now one of the fastest growing arenas for the delivery of services to the geriatric population experiencing difficulty with communication, cognition, and/or swallowing function.  New graduates are pouring out of training institutions and jumping right into long-term care with little or no guidance.  The Long-Term Care Companion was born out of this reality.

The Long-Term Care Companion addresses long- and short-term goal selection and activities for geriatric clients within residential settings who are experiencing aphasia, apraxia, dysarthria, dysphagia, and dementia.  Most goals and suggested lessons involve realistic activities of daily living with functional tasks that will require very little preparation.  I have attempted to create extremely natural types of treatment that fit into everyday living within a skilled nursing facility.  As you adapt these goals to fit the needs of your individual client, add accuracy levels as appropriate.

If you choose to work in long-term care, you have a great challenge ahead.  Your clients will be very medically compromised, advanced in age, and have less rehabilitation potential than any other neurologically-impaired group.  You'll work with other professionals who may not understand your role within the long-term care setting.  You'll encounter families who wish to withdraw all medical treatment for their impaired, elderly relatives.  You may be asked to compromise your professional ethics in an effort to maximize billable productivity.  You'll need to decide what is right and what is wrong for you and your clients as you're forced to make important decisions on a daily basis.  You might feel isolated from other speech-language pathologists, and you'll need to continue networking.  Finally, your rewards will come in small steps as you nurture and facilitate your clients' communication and/or swallowing functions.

It is my hope that The Long-Term Care Companion will prove to be extremely helpful to any clinician working within this setting.  The evolution of long-term care continues and the ride will be no less turbulent than it has been over the past ten years.  Only now, you'll have a realistic guide—The Long-Term Care Companion.