Goal Bank Speech Therapy for SNF

Goal Bank for speech therapists working in a skilled nursing facility. Goals for Cognition, Memory, Attention, Problem Solving, Aphasia, Dysarthria, Voice, Swallowing, Tracheostomy, and Skilled Maintenance. For an all in one download please see end of document.

ST Goal Bank

Cuing Hierarchy

Independent

Setup/cleanup assistance

Supervision or touching assistance

Partial/mod assist

Substantial/maximal assistance

Dependent

COGNITION

• Pt will complete further cognitive assessment (SLUMS/RIPA/ALFA/ACA) in order to assess cognitive communication skills by (DATE).
• Pt will be able to verbally express compensatory strategies to improve cognition in order to return to PLOF.

MEMORY

Long-Term Goal

• Pt will increase memory abilities to (independence/setup/supervision/mod assist/max assist/dependent) demonstrating improved (orientation, basic functional recall of everyday activities, biographical information, safety precautions) in order to (return to PLOF/increase independent on nursing unit).
• Pt will increase memory to (independence/setup/supervision/mod assist/max assist/dependent) demonstrating independence with (functional memory tasks, use of compensatory strategies and precautions, recall of medication schedule) in order to (return to PLOF/increase independence on nursing unit).

Short-Term Goal

• Pt will complete further memory assessment with (SLUMS/RIPA) in order to determine current cognitive level and goal set appropriately.
• Pt will utilize memory book with ___% accuracy with (independence/setup/supervision/mod assist/max assist) in order to assist with everyday functional recall.
• Pt will utilize external/internal memory strategies to solve functional (immediate/short-term/working) memory tasks at (independence/setup/supervision/mod assist/max assist) with ___% accuracy to return to PLOF.

ATTENTION

Long-Term Goal

• Pt will complete (alternating/sustained/selective) attention activities with (independence/setup/supervision/mod assist/max assist/dependent) in order to increase independence with functional activities.

Short-Term Goal

• Pt will complete alternating attention tasks with ___% accuracy given (independence/setup/supervision/mod assist/max assist/dependent) cues to attend in a noisy environment in order to increase independence during functional tasks.
• Pt will sustain attention to (visual information/auditory information/activity) for ___ minutes in a quiet environment given (independence/setup/supervision/mod assist/max assist/dependent) to increase independence during functional tasks.
• Pt will selectively attend to (visual/auditory information/activity) for __ minutes given (independence/setup/supervision/mod assist/max assist/dependent) to attend to functional activities.

PROBLEM SOLVING

Long-Term Goal

• Pt will demonstrate problem solving skills with (independence/setup/supervision/mod assist/max assist/dependent) or higher, demonstrating improved (insight, safety, executive functioning, reasoning, functional problem solving) in order to return to (IADL’s, increase independence on nursing unit).
• Pt will demonstrate problem solving skills with (independence/setup/supervision/mod assist/max assist/dependent) or higher, demonstrating improve problem solving required for independence with basic ADL’s and safety.

Short-Term Goal

• Pt will complete ALFA assessment in order to determine patients’ problem-solving functioning to goal set appropriately.
• Pt will complete basic problem-solving tasks related to safety (use of call light/walker/O2 precautions) at __% accuracy with (independence/setup/supervision/mod assist/max assist/dependent) cues in order to (return to PLOF/increase independence on nursing unit).
• Pt will sequence functional activities with ___% with (independence/setup/supervision/mod assist/max assist/dependent) in order to (return to PLOF/increase independence on nursing unit).
• Pt will complete higher-level problem-solving tasks r/t IADL’s at ___% accuracy given (independence/setup/supervision/mod assist/max assist/dependent) cues in order to (return to PLOF).

SOCIAL INTERACTION

Long-Term Goal

• Pt will increase social interaction to (independence/setup/supervision/mod assist/max assist/dependent) demonstrating increased ability to (manage emotions, cope, engage in social communication, maintain topic, use appropriate pragmatics, turn-take).
• Pt will increase social interaction to (independence/setup/supervision/mod assist/max assist/dependent) or higher demonstrating improved (behavior, pragmatics, eye contact, emotional regulation, coping with anxiety/depression.

Short-Term Goal

• Caregivers/Staff will be able to teach back pt behavioral plan to manage (agitation/restlessness/anxiety/depression) in order to improve quality of care.
• Pt will demonstrate techniques of emotional regulation to manage negative ideation and behavior (deep breathing, positive thinking, mindfulness) with (independence/setup/supervision/mod assist/max assist/dependent in order to benefit quality of life.
• Pt will communicate in social interactions given (independence/setup/supervision/mod assist/max assist/dependent) for (turn taking, eye contact, pragmatics, appropriateness) in order to increase appropriate social interactions with staff/residents/family.

APHASIA RECEPTIVE

Long-Term Goal

• Pt will demonstrate (verbal/written) expression skills with (independence/setup/supervision/mod assist/max assist/dependent) concerning improved (motor speech, word finding, fluency, voice, initiation, pragmatics) in order to express (simple wants/needs/higher level/complex ideas).

Short-Term Goal

• Pt will answer simple biographical yes/no questions presented (verbally/visually) with ___% accuracy with (independence/setup/supervision/mod assist/max assist/dependent) cues in order to increase ability to communicate simple biographical information.

• Pt will follow (simple/complex 1-step commands/2-step commands) with ___% accuracy given (independence/setup/supervision/mod assist/max assist/dependent) cues in order to increase ability to complete functional tasks.
• Pt will identify the correct picture in a field of (2/4/6) when presented with the word (verbally/visually) at ___% accuracy given (independence/setup/supervision/mod assist/max assist/dependent) cues in order to increase ability to recognize functional language.
• Pt will read (sentences/paragraphs) and answer comprehension questions with ___% accuracy given (independence/setup/supervision/mod assist/max assist/dependent) cues in order to improve functional communication.

APHASIA EXPRESSIVE

Long-Term Goals

• Pt will be able to communicate using (simple/complex) (words/phrases/sentences) with (independence/setup/supervision/mod assist/max assist/dependent) in order to increase ability to express (simple/complex) (wants/needs/ideas/feelings).

Short-Term Goals

• Pt will name common objects at __% accuracy with (independence/mod assist/max assist) given (phonemic/orthographic/semantic) cues in order to increase ability to express wants/needs.
• Pt will generate sentences with 3 or more words in response to a situation with __% accuracy with (independence/mod assist/max assist) given (phonemic/orthographic/semantic) in order to increase ability to communicate basic wants and needs.
• Pt will participate in (simple/complex) conversation with ___% accuracy with situation with __% accuracy with (independence/mod assist/max assist) given (phonemic/orthographic/semantic) in order to increase ability to communicate complex thoughts, feelings, and needs.

DYSARTHRIA

Long-Term Goal

• Pt will produce (vowels/phrases/paragraphs/conversation) with appropriate intelligibility given (independence/setup/supervision/mod assist/max assist/dependent) cues in order to increase ability to express wants and needs.

Short-Term Goal

• Pt will produce (vowels/phrases/paragraphs) with appropriate voicing in ___% of opportunities given (independence/setup/supervision/mod assist/max assist/dependent) cues in order to increase ability to express wants and needs.
• Pt will produce phrases with (5 or fewer words/7 or more) in one breath in __% of opportunities with (independence/setup/supervision/mod assist/max assist/dependent) cues in order to increase ability to express wants/needs.
• Pt will produce phrases with appropriate stress in __% of opportunities given (independence/setup/supervision/mod assist/max assist/dependent) cues in order to increase ability to express wants/needs.

VOICE

Long-Term Goal

• Pt will produce (words/phrases) with appropriate voicing with (independence/setup/supervision/mod assist/max assist/dependent) in order to express wants/needs.

Short-Term Goal

• Pt will produce (easy onset/non-nasal/tense vowels/minimal pairs) words with appropriate voicing in ___% of opportunities with (independence/setup/supervision/mod assist/max assist/dependent) cues in order to increase ability to express wants/needs.

• Pt will produce (words/phrases) at (70dB/80dB) vocal loudness with (independence/setup/supervision/mod assist/max assist/dependent) cues in order to increase ability to express wants/needs.
• Pt will improve MPT to __ml with (independence/setup/supervision/mod assist/max assist/dependent)  to demonstrate increased breath support req for voicing.

COMPREHENSION

Long-Term Goal

• Pt will d/c with (independence/setup/supervision/mod assist/max assist/dependent) in order to increase comprehension (reading/expression) of (simple/complex) ideas and instruction.
• Pt will d/c with (independence/setup/supervision/mod assist/max assist/dependent) (reading/expression) in order to increase comprehension of functional information.

Short-Term Goal

• Pt will follow (1/2/3) step directions at (independence/setup/supervision/mod assist/max assist/dependent) level with ___% accuracy in order to complete functional activities.
• Pt will respond to (simple/complex) questions at (independence/setup/supervision/mod assist/max assist/dependent) level with __% accuracy in order to increase ability to participate in functional communication.
• Pt will respond to (simple/complex) questions at independent level with __% accuracy demonstrating improved auditory processing/comprehension
• Pt will answer paired Y/N questions at with __% accuracy at (independence/setup/supervision/mod assist/max assist/dependent) in order to increase ability to participate in functional communication.
• Pt will identify (object/pic/word) in a field of (2/4/6) with ___% accuracy with (independence/setup/supervision/mod assist/max assist/dependent) in order to participate in functional activities.

AAC GOAL

Long-Term Goal

Pt will be able to use (low tech/high tech) AAC device with (independence/setup/supervision/mod assist/max assist/dependent) cues in order to communicate basic wants/needs.

Short-Term Goal

Pt will (type/identify) single (words/icons) with ___% accuracy given (independence/setup/supervision/mod assist/max assist/dependent) cues in order to communicate basic wants/needs.

Pt will answer simple biographical questions at __% accuracy given (independence/setup/supervision/mod assist/max assist/dependent) cues in order to increase functional communication.

Pt will be able to navigate device with ___% accuracy given (independence/setup/supervision/mod assist/max assist/dependent) cues in order to increase independence with device.

Pt will be able to add new (icons/vocabulary) to AAC device with ___% accuracy with (independence/setup/supervision/mod assist/max assist/dependent) cues in order to increase functional communication.

SWALLOWING

Long-Term Goal

• Pt will d/c on IDDSI diet of (Regular-7/Easy to Chew-7b/Soft and Bite Size-6/Minced and Moist-5/Puree-4) (Thin/Nectar Thick) liquids) with (independence/setup/supervision/mod assist/max assist/dependent) use of swallow strategies in order to improve (oral/pharyngeal) swallowing safety and improve (nutrition/hydration)
• Pt will d/c on PO diet maintaining nutritional needs PO requiring no alternative means of nutrition (IV/PEG/NG).
• Pt/caregiver will demonstrate/verbalize understanding of diet recommendations, swallowing strategies, swallowing exercises for (home/facility) maintenance program.

Short-Term Goal

• Pt will complete instrumental swallow evaluation to assess swallow function and determine appropriate diet level.
• Pt/caregiver will demonstrate understanding of oral care and be able to follow oral care program with (independence/setup/supervision/mod assist/max assist/dependent) in order to benefit oral health.
• Pt will decrease (oral pocketing/anterior labial spillage) with ___% accuracy with (independence/setup/supervision/mod assist/max assist/dependent) to reduce risk of aspiration.
• Pt will manage trials of (Regular-7/Easy to Chew-7b/Soft and Bite Size-6/Minced and Moist-5/Puree-4) following swallowing strategies with ___% accuracy with (independence/setup/supervision/mod assist/max assist/dependent) in order to decrease s/s of aspiration.
• Pt will complete (pharyngeal/oral motor exercises) with (independence/setup/supervision/mod assist/max assist/dependent) in order to increase swallow function.

TRACH/DECANNULATION

Secretion Management/Suctioning Goal

• Pt will independently manage secretions as demonstrated by requiring no suction (deep or oral suction) over __hr period.
• Pt will utilize quad cough at spv level to clear deep secretions and req no deep suction over __hr period.
• Pt with demonstrate ability to clear pharyngeal secretions without need for deep suction over __period.
• Pt will independently utilize yanker to clear oral secretions
• Pt will decrease anterior spillage of saliva req __ cueing to clear secretions
•  Pt will increase awareness of drooling req __ cues in __ min/sessions to wipe/mng secretions
• Pt will improve labial seal in order to decrease anterior spillage of secretions by meeting IOPI peak of __ kPa when measuring lip strength
• Pt will improve lingual strength req to mng secretions as demonstrated by IOPI peak of __kPa when measuring base of tongue strength.

DECANNULATION

Long-Term Goal

• Pt will meet decannulation goals in order to increase independence to return to PLOF.

Short-Term Goal

• Pt will tolerate uncuffed trach for __ hrs/days in order to demonstrate readiness for passy muir speaking valve
• Pt will down size to _ size trach in order to tolerate PMSV/demonstrate readiness for capping trials
• Pt will tolerate PMSV for __hrs in order to increase independence with verbal communication
• Pt will tolerate PMSV for __hrs in order to demonstrate readiness for capping trials and decannulation
• Pt will tolerate capping trials for __min/hrs in order to work towards decannulation
• Pt will be decannulated in order to improve swallow function/in order to improve verbal communication
• Pt and family will demonstrate understanding of trach related goals
• Pt/family will demonstrate understanding of trach/pmsv care (placement/clearing)
• Pt will meet incentive spirometer peak of __ ml to demonstrate improved breath support req for decannulation
• Pt will meet __ syllables per breath over 3 trials demonstrating improved breath support req for decannulation
• Pt will meet MPT of ___ sec over 3 trials to demonstrate breath support req for decannulation
• Pt will digitally occlude (stoma/trach) to improve breath support req for intelligible speech at __ level.

SKILLED MAINTENANCE

Long-Term Goals

• Pt will maintain cog/communication skills at level of (independence/setup/supervision/mod assist/max assist/dependent) with implementation of __% verbal cues and environmental modifications to decrease risk of cognitive decline.
• Pt will maintain comprehension skills at (independence/setup/supervision/mod assist/max assist/dependent) with implementation of min cues during discussion of familiar topics to decrease risk of social isolation and to facilitate communication opportunities.
• Pt will maintain current diet with pleasure feedings with SLP in order to benefit quality of life.

Short-Term Goals

• Pt will maintain safe swallow function while consuming (thin liquids/texture) by (spoon/cup/straw) with SLP only for pleasure feedings.
• Pt will continue to engage in 3-minute social interactions with staff during daily care in order to maintain communication skills.
• Pt will maintain short-term memory skills using a memory book and verbal cues from staff in 80% of opportunities.
• Pt will maintain ability to recall self-relevant pieces of information at __% accuracy with verbal/visual cues to maintain ability to recall events and leisure activities scheduled.
• Pt will maintain current reasoning skills at ___% accuracy and occasional (min/mod) cues to prevent cognitive decline and to maintain independence within this environment.
• Pt will maintain thought organizational skills at __% accuracy and occasional cues with task modifications as needed to prevent cognitive decline within this environment.
• Pt will maintain ability to respond to yes/no questions at __% accuracy with implementation of verbal cues to increase ability to engage in meaningful interactions.
•  Pt will demonstrate ability to use verbal and non-verbal communication to make decisions related to preferences during care tasks and daily routine with (independence/setup/supervision/mod assist/max assist/dependent) to facilitate highest level of independence in current environment.
• Pt will maintain ability to complete 3 conversational exchanges related to direct and observable topics using multisensory stimuli in order to reduce risk of social isolation.
• Pt will maintain current level of cognitive-communication to actively participate (following along with handout, switching between tasks, singing along, etc) in weekly activity with (independence/setup/supervision/mod assist/max assist/dependent) in order to maintain quality of life and highest level of independence with leisure activities of choice.