National Nursing Assistants Week, observed in the USA annually from June 11-17, recognizes the extraordinary contributions of Certified Nursing Assistants (CNAs), nursing assistants, home health aides, and patient care technicians across healthcare settings.

While discussions surrounding dysphagia management frequently focus on Speech-Language Pathologists, neurologists, rehabilitation teams, nurses, and physicians, the reality is that many of the most important swallowing-related observations occur through the individuals providing the greatest amount of direct daily care.

For individuals living with Parkinson's disease, stroke, dementia, ALS, Multiple Sclerosis, frailty, and other neurologic conditions, nursing assistants often spend more time observing mealtime performance, hydration habits, feeding challenges, fatigue, and functional swallowing changes than any other member of the interdisciplinary care team.

As healthcare systems increasingly emphasize person-centered care, it may be time to recognize nursing assistants not simply as care providers, but as critical partners in dysphagia surveillance, hydration support, and early identification of swallowing-related decline.
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Dysphagia Is a Daily Care Issue, Not Merely a Clinical Evaluation Issue

Instrumental assessments such as videofluoroscopic swallow studies (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES) remain essential for identifying swallowing physiology and informing treatment recommendations.

However, dysphagia management does not occur during a modified barium swallow study.
It occurs during breakfast.
It occurs during medication administration.
It occurs during hydration opportunities between meals.
It occurs during periods of fatigue, illness progression, cognitive fluctuation, and caregiver transition.

Research continues to demonstrate that swallowing performance may vary substantially throughout the day and across environments, particularly among neurologically complex populations. For this reason, frontline caregivers frequently become the first individuals to recognize subtle changes such as:

• prolonged mealtimes
• increased coughing during meals
• reduced fluid intake
• oral residue
• medication swallowing difficulties
• fatigue-related swallowing decline
• decreased self-feeding independence
• changes in feeding behavior
• reduced meal completion

These observations often precede formal referrals and instrumental assessment.
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Nursing Assistants as Essential Contributors to Dysphagia Detection

The importance of nursing assistant observations is increasingly supported by research emphasizing interdisciplinary approaches to dysphagia identification and management. A multinational consensus statement on dysphagia in Parkinson's disease highlighted the importance of ongoing screening and monitoring across care settings, recognizing that swallowing dysfunction frequently evolves throughout disease progression and may remain underrecognized until complications emerge. Source: Cosentino G, Avenali M, Schindler A, et al. A multinational consensus on dysphagia in Parkinson's disease: screening, diagnosis and prognostic value. Journal of Neurology. 2022.

Similarly, the growing literature surrounding aspiration pneumonia consistently demonstrates that aspiration risk extends beyond isolated swallow physiology and is influenced by multiple factors including oral hygiene, dependency during feeding, functional status, cognitive impairment, and caregiver support. Source: Langmore SE, Skarupski KA, Park PS, Fries BE. Predictors of aspiration pneumonia in nursing home residents. Dysphagia. 2002.

Importantly, many of these variables are most readily observed by nursing assistants and direct care staff.
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Hydration: One of the Most Underrecognized Responsibilities of Frontline Care Teams

Hydration remains a persistent challenge among older adults and individuals with neurological disease. While dysphagia clinicians often focus on aspiration risk and swallowing physiology, frontline caregivers are frequently responsible for monitoring actual fluid intake throughout the day. Research has demonstrated significant rates of dehydration among older adults across healthcare environments, with dysphagia serving as a recognized contributing factor. Source: Vivanti AP, Harvey K, Ash S, Battistutta D. Clinical assessment of dehydration in older people admitted to hospital. Journal of Nutrition Health and Aging. 2008.

For many individuals living with neurological disease, hydration status may influence:

• cognition
• fatigue
• medication effectiveness
• rehabilitation participation
• constipation risk
• hospitalization risk
• overall quality of life

Yet hydration surveillance frequently depends upon the diligence and observational skills of nursing assistants providing day-to-day care.
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Bridging the Gap Between Clinical Recommendations and Real-World Implementation

One of the greatest challenges in dysphagia management is not creating recommendations. It is implementing them consistently. Speech-Language Pathologists may develop evidence-based swallowing recommendations, but successful implementation often depends upon direct care providers who assist with meals, hydration, positioning, pacing, and monitoring. This implementation gap becomes increasingly important within:

• skilled nursing facilities
• long-term care
• home health
• assisted living
• inpatient rehabilitation
• memory care environments

As dysphagia management evolves toward more functional and person-centered models, the contributions of nursing assistants deserve greater recognition.
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The Role of Assistive Technology in Supporting Frontline Care

Adaptive intake technologies represent one strategy for supporting both individuals with dysphagia and the caregivers responsible for assisting them. The RoseCup® System is an adaptive drinking system designed to support more controlled fluid intake through configurable flow regulation and reduced need for excessive head tilt during drinking. For nursing assistants, home health aides, and caregivers assisting individuals with neurological disease, adaptive drinking technologies may help support:

• hydration opportunities
• drinking stability
• self-feeding independence
• caregiver efficiency
• adherence to swallowing recommendations
• person-centered mealtime participation

Importantly, assistive technologies should not be viewed as replacements for skilled clinical care. Rather, they may help support accessibility and implementation of clinical recommendations across everyday environments where swallowing management actually occurs.
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Recognizing the Professionals Who Make Dysphagia Care Possible

National Nursing Assistants Week offers an opportunity to acknowledge a reality often overlooked within dysphagia care. Many swallowing-related complications are identified not during instrumental examinations, but through the observations of dedicated frontline caregivers. These professionals witness the daily realities of dysphagia.They recognize subtle changes. They support hydration. They assist with meals. They encourage participation. They provide dignity.

As healthcare continues moving toward interdisciplinary and person-centered models of care, nursing assistants deserve recognition not only for the physical assistance they provide, but for their essential role in supporting safe intake, hydration, quality of life, and functional swallowing outcomes for some of healthcare's most vulnerable populations.

Jessica Ackerman, MS,CCC-SLP, is a Speech-Language Pathologist and dysphagia specialist with more than 25 years of experience in swallowing disorders, neurological rehabilitation, digital health, and healthcare innovation. As a clinical consultant to Lifemere, she is passionate about advancing person-centered dysphagia care through education, innovation, and practical solutions that support hydration, participation, independence, and quality of life.

Link to relevant articles:

Dysphagia Management Beyond Diet Modification: Reframing Clinical Goals Toward Hydration, Participation, and Quality of Life

Dysphagia Awareness Month 2026: Expanding the Conversation Beyond Aspiration to Functional Living and Assistive Technology