Dysphagia Knowledge Hub — 吞嚥困難知識庫

Building Your Dysphagia Care Team in Hong Kong: Who Does What and How to Coordinate

Dysphagia rarely requires just one clinician. Effective management draws on a team — a speech-language therapist assessing swallowing, a dietitian managing nutrition, an occupational therapist adapting the environment, a nurse monitoring for complications, a doctor managing the underlying condition, and sometimes a care manager coordinating everything together. For family caregivers in Hong Kong, understanding who does what — and how to bring these people into productive communication — makes an enormous difference to outcomes.

This guide explains each role and offers practical advice on how to coordinate care from the family’s perspective.

The Speech-Language Therapist (SLT)

The SLT is the central clinician in dysphagia management. Their responsibilities include:

• Assessment. The SLT evaluates swallowing function through clinical bedside assessment, or through instrumental investigations (videofluoroscopic swallowing study or FEES — fibreoptic endoscopic evaluation of swallowing) when a more detailed picture is needed.
• Prescribing texture and fluid levels. Based on the assessment, the SLT prescribes the appropriate IDDSI level for both food and liquids separately. This is a clinical recommendation — not a general guideline — and should be followed precisely.
• Compensatory strategies. The SLT teaches techniques that make swallowing safer, such as the chin tuck, head rotation toward a weaker side, or pacing strategies during meals.
• Caregiver training. The SLT trains the people who help the patient eat — explaining what to look for, how to prepare food safely, and when to be concerned.
• Reassessment. Swallowing function can change — sometimes improving with rehabilitation, sometimes declining with disease progression. The SLT reassesses periodically and adjusts the prescription accordingly.

In Hong Kong: SLT services in the Hospital Authority are available in inpatient and outpatient settings. Community SLT services are available through some NGO-run programmes. Private SLT practice is also available without referral. If your family member has been discharged without an SLT follow-up date, request one from the ward doctor before discharge.

The Dietitian

Dysphagia and malnutrition are closely linked — eating less, eating more slowly, and avoiding certain textures all reduce caloric and nutritional intake. The dietitian’s role is to make sure the person is adequately nourished despite the dietary restriction imposed by dysphagia.

What the dietitian does:

• Reviews the person’s weight, nutritional status, and dietary intake
• Calculates protein and calorie requirements and assesses whether these are being met
• Recommends oral nutritional supplements (ONS) if needed — commonly used products include Ensure, Fortisip, and Resource, all of which are available in HK and can be used at various IDDSI fluid levels
• Coordinates with the SLT on which foods can be fortified or enriched to increase nutritional value within the prescribed texture level
• Monitors for specific deficiencies (iron, vitamin B12, vitamin D) that commonly occur in people on restricted diets

Questions to ask the dietitian:

• Is the current weight stable? If not, what is the plan?
• Which products would you recommend to increase calorie and protein intake within the current IDDSI level?
• Do we need to supplement anything specific given the current diet?

The Occupational Therapist (OT)

The OT’s focus is on function — specifically, on making safe eating and drinking possible within the person’s physical capabilities and home environment.

What the OT does:

• Assesses seating, posture, and positioning for mealtimes
• Recommends and arranges adaptive equipment (angled spoons, non-slip mats, two-handled cups, plate guards, weighted cutlery)
• Conducts home visits to identify environmental barriers and suggest modifications
• Addresses upper limb function — if the person has difficulty lifting a cup or controlling a spoon, the OT works on strategies to maintain independence or designs a safe assisted feeding approach

In Hong Kong: OT services are available through HA inpatient and day hospital services, community OT teams, and private OT practice. Request an OT referral if the person is struggling with self-feeding or if the home environment needs assessment for mealtime safety.

The Nurse

Nursing staff play a critical monitoring role in both inpatient and community settings.

• In hospital: ward nurses implement the mealtime care plan prescribed by the SLT and dietitian, monitor for aspiration signs, document incidents, and communicate clinical changes to the medical team.
• In the community: visiting nurses (through HA community nursing services or SWD-funded home care) can monitor weight, check for signs of aspiration pneumonia, and provide practical support for oral care and medication management.

If you notice a change in the person’s condition between clinic appointments — increased coughing at meals, fever, reduced appetite, weight loss — the visiting nurse is often the quickest route to clinical assessment without needing to go to A&E.

The Doctor

The doctor (whether GP, specialist, or geriatrician) manages the underlying condition causing dysphagia and authorises referrals to other team members.

• For stroke patients, the neurologist or geriatrician oversees neurological recovery and can adjust medications that affect swallowing
• For Parkinson’s disease patients, optimising dopaminergic medication timing can measurably improve swallowing function — the neurologist should be aware of the dysphagia and its timing relative to medication doses
• For dementia patients, the psychogeriatrician or geriatrician manages the overall care trajectory and can advise on goals of care as dysphagia progresses

The GP is often the most accessible clinician for day-to-day concerns and can make urgent referrals when needed.

The Care Manager

For families accessing subsidised community care services through the Social Welfare Department or HA, a care manager (sometimes called a case manager or social worker) coordinates services from different providers. This person ensures that the different services — home care workers, day care attendance, nursing visits, OT follow-up — are aligned and that the family has a single point of contact for questions.

If you do not have a care manager and the care situation is complex, ask the MSW at the treating hospital for a formal case management referral.

How to Coordinate the Team

In practice, team members often work in different departments, see the patient at different times, and may not communicate with each other as consistently as families would expect. Here is how to bridge those gaps:

Keep a portable care summary. A one-page document with the person’s name, diagnoses, current IDDSI level, thickener product and dose, current medications, and SLT/dietitian contact information. Bring this to every appointment and hand it to each new clinician.

Be the communication link. When one team member gives you new information (e.g., the SLT changes the fluid level from IDDSI 2 to IDDSI 3), inform the other team members at your next contact — “The SLT reviewed last week and changed the fluid level. Can you update your records?”

Request a joint meeting if needed. If care is fragmented and conflicting advice is coming from different clinicians, ask the ward doctor or MSW to arrange a case conference. Multidisciplinary team meetings are standard practice in inpatient rehabilitation units and can sometimes be arranged in community settings when warranted.

Write things down. After every appointment with any team member, write a brief note: date, who you spoke with, what was decided, and what the next step is. This record becomes invaluable when a new clinician asks what has happened before.

When the Team Is Not Working

If the care coordination is failing — conflicting advice, missed follow-up, no response to urgent concerns — contact the Patient Relations Office of the treating hospital or the Medical Social Work department. These channels exist to resolve breakdowns in care coordination.

References

1. Cichero JA et al. Development of standardised terminology and definitions of texture-modified foods and thickened fluids used in dysphagia management. Dysphagia. 2017.
2. IDDSI Framework v2.0. iddsi.org. 2021.
3. Hospital Authority, HKSAR. Allied Health Services. ha.org.hk.
4. Social Welfare Department, HKSAR. Home and Community Care Services. swd.gov.hk.
5. Ekberg O et al. Social and psychological burden of dysphagia. Dysphagia. 2002.