Dementia: communication, swallowing and therapy

Dementia is the loss of thinking, remembering and reasoning to the point that it interferes with daily life; it is not a normal part of aging.⁠¹ It changes how people find words, follow conversations and, in later stages, swallow. A speech-language pathologist helps keep communication and swallowing working as long as possible, and teaches families how to help (see speech therapy for adults).⁠^2,3

What is dementia?

Dementia is the loss of cognitive functioning (thinking, remembering and reasoning) to such an extent that it interferes with a person’s daily life and activities.⁠¹ It mostly affects older adults, but it is not a normal part of aging: about one-third of people 85 or older may have some form of dementia, by NIA’s estimate, and up to half by NINDS’s.⁠^1,5,18 There is no cure for any type of dementia, but some causes of dementia symptoms can be halted or even reversed with treatment, so a medical check comes first.⁠¹

How common is dementia?

• Adults 65 and older: in a national sample of 3,496 people tested in 2016, 10% had dementia and 22% had mild cognitive impairment; risk rose with every 5 years of age, and dementia was more common among non-Hispanic Black people.⁠⁶
• Alzheimer’s disease: more than 6 million Americans may have it, by NIA’s estimate, and CDC estimates 6.7 million older adults, a number expected to double by 2060; it is the seventh leading cause of death in the US.⁠^5,19

What are the types of dementia?

Dementia can also develop in Parkinson’s disease, with slower thinking, trouble focusing, memory problems, confusion and seeing things that are not there.⁠¹⁸ Not everyone who has had a stroke develops dementia.⁠²⁰

How does dementia affect communication?

Language changes are part of almost every dementia. ASHA lists word-finding difficulty, with long pauses, wrong words and word substitutions, and repetitive language, such as asking the same question again and again.⁠² NIA adds trouble blocking out background noise, using unusual words for familiar objects, and, in people who speak two languages, understanding and using only their first language.⁠^1,23 The changes follow the stages:

How do different types of dementia affect communication?

• Alzheimer’s disease: word-finding trouble often comes early, and damage later reaches the areas of the brain that control language and reasoning.⁠^7,19
• Vascular dementia: problems with language, such as finding the right word or using the wrong one, and symptoms that can begin suddenly as well as gradually.⁠²⁰
• Lewy body dementia: concentration and alertness fluctuate, so the person may seem better one day and worse the next.⁠²¹
• Frontotemporal disorders: the behavioral variant changes personality, behavior and judgment, while primary progressive aphasia changes language first.⁠²²

Is it normal forgetfulness or dementia?

Forgetfulness can be a normal part of aging, and sometimes forgetting which word to use is typical; trouble having a conversation is not.⁠⁴ Mild cognitive impairment (MCI) sits between: people with MCI can still take care of themselves, an estimated 10% to 20% of people 65 or older with MCI develop dementia over a year, and in many cases the symptoms stay the same or improve.⁠²⁴ Depression, blood clots and other treatable conditions can cause memory problems too.⁠^4,5 If you or someone close to you has trouble remembering recent events or thinking clearly, talk with a doctor.⁠⁷

What is primary progressive aphasia?

Primary progressive aphasia (PPA) is aphasia that is the first and most noticeable symptom of a dementia, before changes in memory, behavior or movement; different types of dementia can cause it.⁠⁸ It accounts for about 43% of frontotemporal dementias.⁠²⁵ Its three types are named for the language problem that appears first:⁠²²

• Semantic: slowly losing the ability to understand single words.⁠²²
• Agrammatic: leaving out the small words that link nouns and verbs.⁠²²
• Logopenic: trouble finding words in conversation while still understanding words and sentences; it usually comes with the brain changes of Alzheimer’s disease.⁠²²

People with PPA often benefit from speech-language therapy, and NIDCD says referrals should always be made, for treatment as well as diagnosis.⁠⁸ Treatment has two goals, keeping language skills and learning new ways to communicate, such as a communication notebook of labeled photos, gestures and drawing; NIA advises working with an SLP familiar with PPA, because aphasia after a stroke needs different strategies.⁠²⁶ The evidence is still early: a 2024 Cochrane review of 10 studies with 132 participants found no high-certainty evidence to guide the choice of treatment, with preliminary signs that brain stimulation (tDCS) combined with language therapy may improve word retrieval for trained words.⁠²⁵

How does dementia affect eating and swallowing?

Swallowing problems (dysphagia) are common: an estimated 32.7% to 86.6% of people with dementia have them, more likely as the disease progresses, and they raise the risk of choking and aspiration pneumonia.⁠² In the late stages, people may no longer chew and swallow easily, appetite declines, and weight falls; a common cause of death in Alzheimer’s disease is aspiration pneumonia.⁠^7,27,28 In a study of 323 nursing home residents with advanced dementia followed for 18 months, 85.8% developed an eating problem, 41.1% pneumonia, and 54.8% died.⁠²⁹

What helps someone with dementia eat and swallow safely?

An SLP can assess swallowing and teach safe ways to eat, and doctors can test swallowing and advise on reducing the risk of choking.⁠^3,27 NIA’s tips for caregivers:

• A quiet place to eat: turn off the TV or radio if it distracts.⁠²⁸
• One food at a time, rather than a full plate of choices.⁠²⁸
• Small, soft pieces, and pureed food if swallowing is hard.⁠²⁸
• Upright and awake: do not feed someone who is drowsy or lying down, and keep them upright for at least 20 minutes after the meal.⁠²⁷
• One swallow at a time: make sure the person has swallowed before offering more.⁠²⁷
• No force-feeding: avoid overfeeding or force-feeding, since appetite declines in late stages.⁠²⁸

NIA also advises against straws in the late stages; follow the SLP’s advice for the person.⁠²⁷ Treatment evidence is limited: a 2024 review of 10 studies with 1,360 people found too little to say which dysphagia treatments work best in dementia, and a 2026 meta-analysis of 17 studies with 1,593 people found swallowing training the most helpful, in studies with weaknesses in design.⁠^30,31 In the largest trial of thickened liquids against a chin-down posture, in 515 people with dementia or Parkinson’s disease, pneumonia rates were similar, and dehydration was more common with thickened liquids (6% against 2%).⁠³² Montessori-based programs improved feeding difficulty in care homes, especially combined with spaced retrieval.⁠³³

Should someone with advanced dementia have a feeding tube?

The American Geriatrics Society does not recommend feeding tubes for older adults with advanced dementia: careful hand feeding is as good for survival, aspiration pneumonia, function and comfort, and tube feeding is linked to agitation, more restraints and new pressure ulcers.⁠⁹ A 2021 Cochrane review found no randomized trials; in four studies with 36,816 people, tube feeding did not lengthen survival (low-certainty evidence), it raised the risk of pressure ulcers, and the balance of evidence suggested more pneumonia.⁠¹⁰ The decision rests with the physician, the team and the wishes of the person and their family.⁠²

When is a sudden change an emergency?

Dementia develops over time. A sudden change is something else:

Delirium is sudden, severe confusion from rapid changes in brain function, with causes such as a urinary tract infection or certain medicines; it is usually temporary and reversible, and it can occur on top of dementia. Contact a health care provider for any rapid change in mental status.⁠³⁵

Choking: if the person cannot speak or cough forcefully, have someone call 9-1-1 and give repeated cycles of 5 back blows and 5 abdominal thrusts until the object comes out; do not intervene if they are coughing forcefully and can speak.⁠³⁶

How is dementia diagnosed?

A primary care doctor is often the first step. Doctors first look for treatable conditions that can affect thinking, then take a medical history and use cognitive and neurological tests and brain scans; a blood test alone should not be used to diagnose dementia.⁠¹ Medicare Part B covers a separate visit to review thinking, establish or confirm a diagnosis and build a care plan, and you can bring someone with you.⁠¹⁵

The diagnosis is made by a medical team, and SLPs play a central role in screening, assessing and treating the communication and swallowing side.⁠² Before testing, the SLP considers hearing and vision, depression and medicines, and reevaluates every few months or yearly as needs change.⁠²

Does hearing loss affect dementia?

Yes. Hearing problems can mimic dementia, so a hearing test with an audiologist is recommended.⁠³ Older adults with hearing loss have a greater risk of developing dementia, and people who used hearing aids or cochlear implants had a lower risk of long-term cognitive decline; dementia should not rule out fitting hearing aids.⁠^2,37

What treatments help dementia?

There is no cure for Alzheimer’s disease, but medicines can help some people:⁠³⁸

• Cholinesterase inhibitors (galantamine, benzgalantamine, rivastigmine and donepezil) for mild to moderate symptoms, and memantine for moderate to severe ones.⁠³⁸
• Lecanemab and donanemab, FDA-approved immunotherapies for early Alzheimer’s, slowed cognitive decline in some study participants over 18 months; possible side effects include brain swelling or bleeding (ARIA), and Medicare Part B covers part of the cost for patients who meet the criteria.⁠³⁸
• Medicines for behavior only after non-drug strategies have been tried.⁠³⁸

Does speech therapy help people with dementia?

Yes, with a different goal from therapy after a stroke: to keep communication, thinking and swallowing at the highest possible level throughout the disease, often as maintenance therapy.⁠² Speech and physical therapists can help with problems of movement, speech and swallowing; speech therapy explains what SLPs do.⁠¹⁸ The approaches, and what research found:

Care partner training and changes to the environment are part of the plan too.⁠²

How do you communicate with someone who has dementia?

NIA’s advice, from its guidance for caregivers:

• Make eye contact and call the person by name.⁠²³
• Allow extra time for the person to respond; be patient and try not to interrupt.⁠^23,43
• Use yes or no questions, and if you are not understood, try different words.⁠^23,43
• Include the person: do not talk about them as if they are not there, or exclude them from conversations.⁠^23,43
• Do not argue, and do not ask whether they remember something or someone.⁠⁴³
• Be aware of nonverbal communication.⁠²³
• Keep it simple: clear, simple choices, short direct sentences, and written words or pictures to support conversation.⁠³

Training helps families and staff. A review of 12 trials found that communication skills training for caregivers improves the quality of life and wellbeing of people with dementia and increases positive interactions, and a review of 30 studies of programs for families found better communication skills and knowledge, with mixed effects on behavior.⁠^14,44 Medicare Part B covers caregiver training, including by SLPs, without the patient present.⁠¹⁶

What does speech therapy for dementia look like, session by session?

The SLP assesses communication, thinking and swallowing, then works on what matters most to the person and family: written reminders or pictures for daily tasks, communication tips for the family, and safe ways to eat.⁠³ Goals change as the disease progresses, and reevaluations, every few months or yearly, keep the plan current.⁠² A course of outpatient therapy, as Medicare structures it:

How can you keep someone with dementia safe?

• Driving: some people can keep driving in the early stages, but people with dementia often do not realize they are having driving problems, state laws vary, and a doctor can be asked to tell the person to stop; the American Occupational Therapy Association keeps a national database of driving specialists.⁠⁴⁹
• Wandering: many people with Alzheimer’s wander; make sure the person carries ID or wears a medical bracelet, keep a recent photo, and do not leave someone who wanders alone.⁠⁵⁰
• At home: label rooms with brightly colored signs or simple pictures, and add safety knobs and an automatic shut-off to the stove, since the person may not smell smoke or gas.⁠⁵¹
• At meals: follow the eating tips above, and learn what to do if someone chokes.⁠^27,36

What help and benefits are available for dementia care?

• Cognitive assessment and care plan: a Medicare Part B visit to review thinking, confirm a diagnosis, create a care plan and update an advance care plan.⁠¹⁵
• The GUIDE model: a Medicare program that began on July 1, 2024 and runs for 8 years, offering care navigation, a 24/7 support line, caregiver training and education, respite services up to $2,500 a year and connections to community resources; your Medicare benefits stay the same, and you need Parts A and B and cannot be in hospice or living in a long-term nursing home.⁠^52,53
• Hospice: when a doctor certifies a life expectancy of 6 months or less and comfort care is chosen; care continues as long as the hospice doctor recertifies.⁠⁵⁴
• Speech therapy: Medicare Part B covers speech-language pathology, including swallowing and cognitive skills and therapy to maintain function.⁠⁴⁸
• Information and local help: NIA’s ADEAR Center answers questions and refers to local services at 800-438-4380, and the Eldercare Locator connects families to services at 1-800-677-1116.⁠^55,56

Medicaid, Marketplace plans and the VA. For adults, speech, hearing and language services are an optional Medicaid benefit, so coverage depends on your state; home health is a mandatory benefit.⁠⁶⁰ Every Marketplace plan covers rehabilitative and habilitative services and devices, though the specific services vary with each state’s requirements.⁠⁶¹ For veterans, audiology and speech pathology are standard medical benefits for every enrolled veteran.⁠⁶² With any private plan, ask about visit limits, whether a referral is needed, and whether the SLP is in network.

How long do people live with dementia?

It varies with age and type. In a 2025 analysis of studies of more than 5.5 million people, life expectancy at diagnosis ranged from 5.7 years at age 65 to 2.2 years at 85 in men, and from 8.0 to 4.5 years in women; median survival was 1.4 years longer with Alzheimer’s disease than with other types; and 13% of people moved into a nursing home in the first year after diagnosis, 57% by five years.⁠⁶³ In advanced dementia, in one study of nursing home residents, 38.6% died within 6 months after an eating problem developed.⁠²⁹

Which conditions are related to dementia?

• Mild cognitive impairment, which may or may not progress to dementia.⁠²⁴
• Delirium, sudden confusion that can occur on top of dementia.⁠³⁵
• Hearing loss, which can mimic dementia and is linked to a higher risk of it.⁠^3,37
• Depression, which can cause memory problems.⁠⁴
• Parkinson’s disease and stroke: dementia can develop with Parkinson’s, and vascular dementia comes from conditions that affect the blood vessels in the brain.⁠^18,20

Other adult speech and swallowing problems have their own causes and treatment: aphasia, cognitive-communication disorders, dysarthria, voice disorders, stuttering in adults, and the changes in speech and swallowing that come with ALS.

What are common myths about dementia?

• Myth: dementia is a normal part of aging. It is not, though it mostly affects older adults.⁠^4,5
• Myth: nothing can be done. Some causes are treatable, medicines help some people, and cognitive stimulation and rehabilitation have trial evidence.⁠^1,11,12,38
• Myth: people with dementia cannot learn anything new. They can still acquire meaningful skills, as errorless learning and spaced retrieval studies show.⁠^40,41
• Myth: a feeding tube helps someone with advanced dementia live longer. Studies found no effect on survival, and careful hand feeding is recommended instead.⁠^9,10
• Myth: asking whether they remember helps them remember. NIA advises against asking whether the person remembers something or someone.⁠⁴³

How do you find a speech therapist for dementia?

Look for an SLP who works with adults with dementia, and, for primary progressive aphasia, one familiar with PPA.⁠^2,26 Every SLP needs a state license. ASHA’s Certificate of Clinical Competence (CCC-SLP) is a national credential whose holders have met standards that typically go beyond state licensure, and anyone can check an SLP’s certification on ASHA’s site.⁠^64,65

The DrSensory speech therapy directory lists practices by state and city. On a city page, set Care for to Adults, then ask the practice about its experience with dementia and with swallowing problems when you call.

If leaving home is hard, Medicare home health covers speech therapy for people who are homebound, and Medicare covers telehealth from home through December 31, 2027.⁠^57,58 In-home therapy explains how home visits work.

Sources

1. National Institute on Aging. What Is Dementia? Symptoms, Types, and Diagnosis. “Dementia is the loss of cognitive functioning — thinking, remembering, and reasoning — to such an extent that it interferes with a person’s daily life and activities”; “about one-third of all people age 85 or older may have some form of dementia) but it is not a normal part of aging”; signs include “Difficulty speaking, understanding and expressing thoughts, or reading and writing” and “Using unusual words to refer to familiar objects”; types: Alzheimer’s (“the most common dementia diagnosis among older adults”), frontotemporal, Lewy body, vascular and mixed; “Currently, there is no cure for any type of dementia”; “Some causes of dementia symptoms can be halted or even reversed with treatment”. Diagnosis: “doctors first assess whether a person has an underlying, potentially treatable, condition that may relate to cognitive difficulties”, then history, cognitive and neurological tests and brain scans; “At present, blood test results alone should not be used to diagnose dementia”; “Visiting a primary care doctor is often the first step”. Checked October 7, 2026.
2. American Speech-Language-Hearing Association. Dementia (Practice Portal). “individuals with frontotemporal dementia may develop primary progressive aphasia, a gradual loss of language function with relatively well-preserved memory”; “Within the United States, an estimated 50,000–60,000 people are currently living with the two types of frontotemporal dementia: primary progressive aphasia and behavioral variant frontotemporal dementia”. Checked October 7, 2026.
3. Communication Health Support Association (powered by the American Speech-Language-Hearing Association). Dementia. “Hearing problems can also mimic dementia symptoms, so seeing an audiologist for a hearing test is recommended”; “An SLP can assess communication, thinking, and swallowing skills”; SLPs help with “written reminders or pictures for daily tasks”, “communication tips for family and caregivers” and “teaching you safe ways to eat and swallow”; tips: “Offer clear, simple choices”, “Use short, direct sentences”, “Support conversations with written words or pictures”. Checked October 7, 2026.
4. National Institute on Aging. Memory Problems, Forgetfulness, and Aging. “Forgetfulness can be a normal part of aging. However, dementia is not a normal part of aging”; normal aging, “Sometimes forgetting which word to use”, versus dementia, “Trouble having a conversation”; “medical conditions, such as depression or blood clots, can cause memory problems”. Checked October 7, 2026.
5. Centers for Disease Control and Prevention. About Dementia. “Though dementia mostly affects older adults, it is not a part of normal aging”; “An estimated 6.7 million older adults have Alzheimer’s disease in the United States. That number is expected to double by 2060”; Alzheimer’s “accounts for 60% to 80% of cases”; “Vascular dementia is the second most common type of dementia”; “About one-third of all FTD cases are inherited through genes”; “Some memory problems may be caused by treatable conditions”. Checked October 7, 2026.
6. Manly JJ, Jones RN, Langa KM, Ryan LH, Levine DA, McCammon R, et al. Estimating the prevalence of dementia and mild cognitive impairment in the US: the 2016 Health and Retirement Study Harmonized Cognitive Assessment Protocol project. JAMA Neurology. 2022;79(12):1242-1249. doi:10.1001/jamaneurol.2022.3543 (PMID 36279130). Nationally representative sample of 3,496 adults 65 and older tested in 2016: “393 individuals (10%; 95% CI, 9-11) were classified as having dementia and 804 (22%; 95% CI, 20-24) as having MCI”; “Every 5-year increase in age was associated with higher risk of dementia”; “Dementia was more common among non-Hispanic Black individuals”.
7. National Institute on Aging. What Are the Signs of Alzheimer’s Disease? Stages: early non-memory signs include “finding the right word”; moderate stage, “Difficulty with language and problems with reading, writing, and working with numbers”; “People with severe Alzheimer’s cannot communicate and are completely dependent on others for their care”, with “Weight loss with little interest in eating” and “Difficulty swallowing”; “A common cause of death for people with Alzheimer’s is aspiration pneumonia”. “If you, a family member, or friend has problems remembering recent events or thinking clearly, talk with a doctor”. Checked October 7, 2026.
8. National Institute on Deafness and Other Communication Disorders. Aphasia. NIH Pub. No. 97-4257, last updated April 16, 2025. “Aphasia is a disorder that results from damage (usually from a stroke or traumatic brain injury) to areas of the brain that are responsible for language”; “For most people, areas in the left side of the brain are affected”; “Aphasia impairs the expression and understanding of language, as well as reading and writing”. “About 2 million people in the United States are living with aphasia, according to the National Aphasia Association”; “Stroke is the leading cause of aphasia. According to the National Aphasia Association, approximately one third of stroke survivors have aphasia”; “Most people who have aphasia are middle-aged or older, but anyone can develop it, including young children”. “Aphasia can appear suddenly, following brain surgery or after a head injury, or it can develop gradually from the effects of a brain tumor (and associated treatments). Other causes of aphasia include brain infections”; “People with progressive neurological disorders, such as Alzheimer’s disease or another form of dementia, may also develop aphasia”. Types: “Most often, aphasia is divided into two broad categories: fluent and nonfluent”; in Wernicke’s aphasia people “may speak fluently in long, complete sentences that have little meaning, adding unnecessary words and even making up words”, are “often unaware of their spoken mistakes”, and have “difficulty understanding language, whether spoken, written, or signed”; “People with Broca’s aphasia frequently speak in short phrases produced with great effort”, “may also have right-sided weakness or paralysis of the arm and leg”, “are usually aware of their speaking difficulties and can become easily frustrated”, and “Broca’s aphasia may co-occur with apraxia of speech”; “global aphasia results from damage to extensive portions of the language areas of the brain”; “People with global aphasia have severe communication difficulties and may be extremely limited in their ability to produce and comprehend language”; “Conduction aphasia is a fluent aphasia in which a person has difficulty repeating words and simple phrases”; “Other subtypes include transcortical aphasia (motor, sensory, or mixed), anomic aphasia, very mild or latent aphasia, and mixed or unspecified presentations of aphasia”. “In some cases, aphasia will be the first and most noticeable symptom of dementia, rather than memory, behavioral, or movement changes. This is called primary progressive aphasia, or PPA”; “PPA can be caused by different types of dementia, such as Alzheimer’s disease, vascular dementia, Lewy Body dementia, and frontotemporal dementia”; “PPA worsens over time, causing the person to eventually lose their ability to use language”; “referrals to speech-language pathologists for people with PPA should always be made, not only for assistance with diagnosis but also for treatment”. After a TIA, “Language abilities may be affected for a few hours or days after a TIA but are usually not permanently affected”. Diagnosis: “The doctor who treats a person for a brain injury, such as a stroke, may be the first to identify aphasia”; “Most individuals with suspected aphasia or PPA will have undergone a diagnostic scan that may confirm the presence and location of brain injury or brain degeneration”; “A doctor may also briefly test the person’s ability to understand and produce language, assessing the ability to follow commands, answer questions, name objects, and carry on a conversation”; “If the doctor suspects aphasia or PPA, the patient should be referred to a speech-language pathologist for a comprehensive examination of the person’s communication abilities”. Treatment: “Aphasia therapy aims to improve the ability to communicate by helping individuals use their remaining language abilities, restore language abilities as much as possible, and learn other ways of communicating, such as through gestures, pictures, notebooks, and/or electronic devices”; “A strong therapy program will include communication partner training as an essential element”; “Speech-generating applications on mobile devices such as cell phones and tablets can provide alternative ways to communicate”; “Virtual meetings with speech-language pathologists provide patients with the flexibility and convenience of receiving therapy in their homes through a computer”. For families: “Participate in therapy sessions”; “Simplify language by using short, uncomplicated sentences”; “Repeat words or write down key words to clarify meaning as needed”; “Maintain a natural conversational manner appropriate for an adult”; “Minimize distractions, such as loud radio or TV”; “Ask for and value the opinion of the person with aphasia, especially regarding family matters”; “Encourage any type of communication, whether it is speech, gesture, pointing, or drawing”; “Avoid correcting the person’s speech”; “Allow the person plenty of time to talk”; “Help the person become involved outside the home”; “Stroke clubs (regional support groups formed by people who have had a stroke) are available in most major cities”; “Participating in activities such as book clubs, technology groups, choirs, and art and drama clubs can help people with aphasia regain their confidence and social self-esteem”. Recovery: “people with aphasia can often experience dramatic improvements in their language and communication abilities in the first few months, even without treatment”; “But in many cases, some aphasia remains following this initial recovery period. This condition is called chronic aphasia”; “Research has shown that language and communication abilities can continue to improve for many years after the brain injury”; “Factors that may influence the amount of improvement include the cause of the brain injury, the area of the brain that was damaged and the extent of the damage, the age and health of the individual, and access to therapy”; “Aphasia may co-occur with speech disorders such as dysarthria or apraxia of speech”. Checked October 7, 2026.
9. American Geriatrics Society Ethics Committee and Clinical Practice and Models of Care Committee. American Geriatrics Society feeding tubes in advanced dementia position statement. Journal of the American Geriatrics Society. 2014;62(8):1590-1593. doi:10.1111/jgs.12924 (PMID 25039796). “When eating difficulties arise, feeding tubes are not recommended for older adults with advanced dementia. Careful hand feeding should be offered because hand feeding has been shown to be as good as tube feeding for the outcomes of death, aspiration pneumonia, functional status, and comfort”; “tube feeding is associated with agitation, greater use of physical and chemical restraints” and “development of new pressure ulcers”.
10. Davies N, Barrado-Martín Y, Vickerstaff V, Rait G, Fukui A, Candy B, et al. Enteral tube feeding for people with severe dementia. Cochrane Database of Systematic Reviews. 2021;(8):CD013503. doi:10.1002/14651858.CD013503.pub2 (PMID 34387363). “We found no eligible RCTs. We included fourteen controlled, non-randomised studies”; “Four studies with 36,816 participants assessed the effect of PEG feeding on survival time. None found any evidence of effects on survival time (low-certainty evidence)”; one study “found PEG feeding increased the risk of pressure ulcers (moderate-certainty evidence)”; “The balance of evidence suggested increased risk of pneumonia with enteral tube feeding”.
11. Woods B, Rai HK, Elliott E, Aguirre E, Orrell M, Spector A. Cognitive stimulation to improve cognitive functioning in people with dementia. Cochrane Database of Systematic Reviews. 2023;(1):CD005562. doi:10.1002/14651858.CD005562.pub3 (PMID 39804128). “We included 37 RCTs (with 2766 participants)”; “moderate-quality evidence for a small benefit in cognition associated with CS”; “high-quality evidence for clinically relevant improvements in staff/interviewer ratings of communication and social interaction”; “improvements in cognition were larger where group sessions were more frequent (twice weekly or more versus once weekly)”; benefits are “small, short-term”, with median treatment length 10 weeks, and “No negative effects were reported”.
12. Kudlicka A, Martyr A, Bahar-Fuchs A, Sabates J, Woods B, Clare L. Cognitive rehabilitation for people with mild to moderate dementia. Cochrane Database of Systematic Reviews. 2023;(6):CD013388. doi:10.1002/14651858.CD013388.pub2 (PMID 37389428). “We identified six eligible RCTs published in English between 2010 and 2022, which together included 1702 participants”; “high-certainty evidence of large positive effects of CR on all three primary outcome perspectives at the end of treatment” (goal attainment); “The review findings were strongly driven by one large, high-quality RCT”; CR “is helpful in enabling people with mild or moderate dementia to improve their ability to manage the everyday activities targeted in the intervention”.
13. Voigt-Radloff S, de Werd MM, Leonhart R, Boelen DH, Olde Rikkert MG, Fliessbach K, et al. Structured relearning of activities of daily living in dementia: the randomized controlled REDALI-DEM trial on errorless learning. Alzheimer’s Research & Therapy. 2017;9(1):22. doi:10.1186/s13195-017-0247-9 (PMID 28335810). “Patients received nine 1-hour task training sessions over eight weeks”; “A total of 161 participants were randomized”; “Structured relearning improved the performance of activities of daily living. Improvements were maintained for 6 months. EL had no additional effect over TEL” (trial-and-error learning).
14. Eggenberger E, Heimerl K, Bennett MI. Communication skills training in dementia care: a systematic review of effectiveness, training content, and didactic methods in different care settings. International Psychogeriatrics. 2013;25(3):345-358. doi:10.1017/S1041610212001664 (PMID 23116547). “This review included 12 trials totaling 831 persons with dementia, 519 professional caregivers, and 162 family caregivers”; “communication skills training in dementia care significantly improves the quality of life and wellbeing of people with dementia and increases positive interactions in various care settings”.
15. Medicare.gov. Cognitive assessment & care plan services. Part B “covers a separate visit with a health care provider to fully review your cognitive function, establish or confirm a diagnosis like dementia or Alzheimer’s disease, and develop a care plan”; the provider may “Create a care plan to help address and manage your symptoms” and “Help you develop or update your advance care plan”; “you can bring someone with you”; after the Part B deductible you pay 20% of the Medicare-approved amount. Checked October 7, 2026.
16. Medicare.gov. Caregiver training services. Part B covers training that teaches a caregiver how to, among other things, “Communicate effectively with the patient”; the caregiver “can get individual or group training sessions from the provider without the patient present”; providers include “Therapists (including physical and occupational therapists, and speech-language pathologists)”; 20% coinsurance after the Part B deductible. Checked October 7, 2026.
17. Centers for Medicare & Medicaid Services. Jimmo settlement. The Jimmo Settlement Agreement (January 2013) “clarified that the Medicare program covers skilled nursing care and skilled therapy services under Medicare’s skilled nursing facility, home health, and outpatient therapy benefits when a beneficiary needs skilled care in order to maintain function or to prevent or slow decline or deterioration (provided all other coverage criteria are met)”; coverage “does not turn on the presence or absence of a beneficiary’s potential for improvement, but rather on the beneficiary’s need for skilled care.” Checked October 7, 2026.
18. National Institute of Neurological Disorders and Stroke. Dementia. Last reviewed May 21, 2026. “Although up to half of all people 85 or older may have some type of dementia, it’s not a normal part of aging”; “Lewy body dementia (LBD) is one of the most common types of dementia”; in Parkinson’s disease, “dementia symptoms can include slower thinking, trouble focusing, memory problems, confusion, and seeing things that aren’t there”; “Speech and physical therapists can help a person with dementia who is having problems with movement, speech, and swallowing”. Checked October 7, 2026.
19. National Institute on Aging. Alzheimer’s Disease Fact Sheet. “Estimates vary, but experts suggest that more than 6 million Americans, most of them age 65 or older, may have Alzheimer’s”; “Alzheimer’s is currently ranked as the seventh leading cause of death in the United States”; in the moderate stage, “damage occurs in areas of the brain that control language, reasoning, conscious thought, and sensory processing”. Checked October 7, 2026.
20. National Institute on Aging. Vascular Dementia: Causes, Symptoms, and Treatments. “Symptoms of vascular dementia can begin gradually or can occur suddenly, and then progress over time, with possible short periods of improvement”; symptoms include “Problems with language, such as finding the right word or using the wrong word”; “not everyone who has had a stroke will develop dementia”. Checked October 7, 2026.
21. National Institute on Aging. Lewy Body Dementia: Causes, Symptoms, and Diagnosis. “Cognitive fluctuations: Unpredictable changes in concentration, attention, alertness, and wakefulness from day to day and sometimes throughout the day”; “The person may seem better one day, then worse the next”; “Visual hallucinations occur in most people with LBD, often early in the disease”. Checked October 7, 2026.
22. National Institute on Aging. Frontotemporal Disorders: Causes, Symptoms, and Diagnosis. “There are three types of PPA, categorized by the language problems that appear first”: “Semantic PPA: A person slowly loses the ability to understand single words and sometimes to recognize the faces of familiar people and common objects”; “Agrammatic PPA: A person has more and more trouble speaking and may omit words that link nouns and verbs (such as to, from, and the)”; “Logopenic PPA: A person has trouble finding the right words during a conversation but can understand words and sentences”. “Logopenic PPA is usually accompanied by the hallmark brain changes seen in Alzheimer’s”; “Many people with PPA develop symptoms of dementia”. Checked October 7, 2026.
23. National Institute on Aging. Communicating With Someone Who Has Alzheimer’s Disease. Content reviewed July 11, 2024. People may struggle with “Finding the right word when speaking” and “Blocking out background noises”; a person may “understand and use only their first language”. Tips: “Make eye contact and call the person by name”; “Allow more time for the person to respond. Be patient and try not to interrupt”; “Don’t talk about the person as if they are not there”; “try to ask questions with a yes or no answer”; “try rephrasing what you said with different words”; “Be aware of nonverbal communication”. Checked October 7, 2026.
24. National Institute on Aging. What Is Mild Cognitive Impairment? “People with MCI are still able to take care of themselves”; “An estimated 10 to 20% of people age 65 or older with MCI develop dementia over a one-year period”; “In many cases, the symptoms of MCI may stay the same or even improve”. Checked October 7, 2026.
25. Roheger M, Riemann S, Brauer A, McGowan E, Grittner U, Flöel A, et al. Non-pharmacological interventions for improving language and communication in people with primary progressive aphasia. Cochrane Database of Systematic Reviews. 2024;(5):CD015067. doi:10.1002/14651858.CD015067.pub2 (PMID 38808659). “Primary progressive aphasia (PPA) accounts for approximately 43% of frontotemporal dementias”; “There is currently no curative treatment for PPA”; “We included 10 studies, with a total of 132 participants”; “Preliminary evidence suggests that the combination of active tDCS with specific language therapy may improve impaired word retrieval for specifically trained items beyond the effects of behavioural treatment alone”; “There is currently no high-certainty evidence to inform clinical decision-making regarding non-pharmacological treatment selection for people with PPA”.
26. National Institute on Aging. How Are Frontotemporal Disorders Treated and Managed? “Treatment of PPA has two goals: maintaining language skills and using new tools and other ways to communicate”; “Use a communication notebook (an album of photos labeled with names of people and objects), gestures, and drawings to communicate without talking”; “Work with a speech-language pathologist familiar with PPA”, noting that “many speech-language pathologists are trained to treat aphasia caused by stroke, which requires different strategies from those used with PPA”. Checked October 7, 2026.
27. National Institute on Aging. Care in the Last Stages of Alzheimer’s Disease. “In the later stages of Alzheimer’s, the person may no longer be able to chew and swallow easily, which increases their risk of choking”; tips: “Don’t use a straw, which may cause more swallowing problems”; “Don’t feed a person who is drowsy or lying down”; upright “for at least 20 minutes after the meal”; “Make sure the person has swallowed before introducing more food”; “Doctors can test the person’s swallowing and give professional advice for how to reduce the risk of choking”. Checked October 7, 2026.
28. National Institute on Aging. Tips for Caregivers: Helping People With Alzheimer’s Disease Eat Well. “Make the eating area quiet. Turn off the TV or radio if they distract the person from eating”; “Offer just one food at a time instead of filling the plate or table with too many options”; “Cut the food into small pieces and make it soft enough to eat, which will help with chewing and swallowing”; “Consider pureeing food if the person has difficulty swallowing”; “Avoid overfeeding or force-feeding. Keep in mind that in late stages of Alzheimer’s, appetite declines”. Checked October 7, 2026.
29. Mitchell SL, Teno JM, Kiely DK, Shaffer ML, Jones RN, Prigerson HG, et al. The clinical course of advanced dementia. New England Journal of Medicine. 2009;361(16):1529-1538. doi:10.1056/NEJMoa0902234 (PMID 19828530). “We followed 323 nursing home residents with advanced dementia and their health care proxies for 18 months in 22 nursing homes”: “Over a period of 18 months, 54.8% of the residents died. The probability of pneumonia was 41.1%; a febrile episode, 52.6%; and an eating problem, 85.8%”; the adjusted 6-month mortality after an eating problem was 38.6%.
30. Chan CTW, Wu TY, Cheng I. A systematic review on dysphagia treatments for persons living with dementia. European Geriatric Medicine. 2024;15(6):1573-1585. doi:10.1007/s41999-024-01107-6 (PMID 39612080). “A total of 10 studies, involving 1360 participants, were included”; “There is currently limited evidence available revealing the efficacy of dysphagia treatments for PLWD”; “no definitive conclusions can be drawn on which treatments are more effective for this population”.
31. Tong L, Chen L, Xiao P, Zhang Y, Cao Q, Zhu W. Treatment of dysphagia in patients with dementia: a systematic review and meta-analysis. Dysphagia. 2026;41(1):10-22. doi:10.1007/s00455-025-10850-2 (PMID 40622605). “Seventeen studies met the inclusion criteria, involving 1,593 participants” (RCTs and quasi-experimental studies, including Chinese databases); “there were weaknesses in randomization, allocation concealment, and blinding”; pooled treatments improved swallowing versus standard care, with swallowing training the strongest subgroup and “interventions lasting 4-6 weeks” showing significant improvement; “higher-quality multicenter studies will be needed for verification”.
32. Robbins J, Gensler G, Hind J, Logemann JA, Lindblad AS, Brandt D, et al. Comparison of 2 interventions for liquid aspiration on pneumonia incidence: a randomized trial. Annals of Internal Medicine. 2008;148(7):509-518. doi:10.7326/0003-4819-148-7-200804010-00007 (PMID 18378947). “515 patients age 50 years or older with dementia or Parkinson disease who aspirated thin liquids” were randomized to a chin-down posture or nectar- or honey-thick liquids; 3-month pneumonia incidence was “0.098 and 0.116 in the chin-down posture and thickened-liquid groups, respectively” (no significant difference); “More patients assigned to thickened liquids than those assigned to the chin-down posture intervention had dehydration (6% vs. 2%)”; “A no-treatment control group was not included”; “No definitive conclusions about the superiority of any of the tested interventions can be made”.
33. Yan Z, Traynor V, Alananzeh I, Drury P, Chang HR. The impact of Montessori-based programmes on individuals with dementia living in residential aged care: a systematic review. Dementia. 2023;22(6):1259-1291. doi:10.1177/14713012231173817 (PMID 37177991). “Fifteen studies were included in this review”: “significantly improved engagement”, “significantly improved feeding difficulty but mixed results regarding nutritional status” and “no significant changes in the activities of daily living and quality of life”; “The synergistic effect of integrating Spaced Retrieval with Montessori-based activities in improving the eating ability and nutritional status of individuals with dementia was also noticed”.
34. Centers for Disease Control and Prevention. Signs and symptoms of stroke (May 19, 2026). Signs include “Sudden confusion, trouble speaking, or difficulty understanding speech”; “Call 9-1-1 right away if you or someone else has any of these symptoms”; in the B.E. F.A.S.T. test for speech, “Ask the person to repeat a simple phrase. Is the speech slurred or strange?”; “The stroke treatments that work best are available only if the stroke is recognized and diagnosed within 3 hours of the first symptoms”; “Note the time when any symptoms first appear”; “Do not drive to the hospital or let someone else drive you”; a TIA “is a sign of a serious condition that will not go away without medical help”, so “tell a health care team about the symptoms right away.” Checked October 7, 2026.
35. MedlinePlus Medical Encyclopedia (U.S. National Library of Medicine). Delirium. Review date October 27, 2025. “Delirium is sudden severe confusion due to rapid changes in brain function that can occur with physical or mental illness”; it “is usually temporary and reversible”; causes include “Infections such as urinary tract infections” and certain medicines; “Acute conditions that cause delirium may occur with long-term ( chronic ) disorders that cause dementia”; “Contact your health care provider if there is a rapid change in mental status”. Checked October 7, 2026.
36. MedlinePlus Medical Encyclopedia (U.S. National Library of Medicine). Choking – adult or child over 1 year. Review date February 10, 2026. Danger signs: “Inability to speak”, “Difficulty breathing”, “Weak, ineffective coughing”; “Do not perform first aid if the person is coughing forcefully and is able to speak”; “You should perform repeated cycles of 5 back blows followed by 5 abdominal thrusts, until the object comes out or the person becomes unconscious”; “Tell someone to call 911 or the local emergency number”. Checked October 7, 2026.
37. National Institute on Aging. Hearing Loss: A Common Problem for Older Adults. “Studies have shown that older adults with hearing loss have a greater risk of developing dementia than older adults with normal hearing”; “people who used hearing restorative devices (such as hearing aids and cochlear implants ) had a lower risk of long-term cognitive decline”. Checked October 7, 2026.
38. National Institute on Aging. How Is Alzheimer’s Disease Treated? “There are currently no known interventions that will cure Alzheimer’s”; “Galantamine, benzgalantamine, rivastigmine, and donepezil are cholinesterase inhibitors that are prescribed for mild to moderate Alzheimer’s symptoms”; memantine “can be prescribed for moderate to severe Alzheimer’s”; “Lecanemab and donanemab are FDA-approved immunotherapy drugs for the treatment of early Alzheimer’s”, which “slowed the rate of cognitive decline among some study participants over the course of 18 months”, with possible side effects including “amyloid-related imaging abnormalities (ARIA), which can lead to fluid buildup or bleeding in the brain”; “Medicare Part B covers part of the cost of these medications for patients who meet certain medical criteria”; medicines for behavior problems “should be used only after other non-drug strategies have been tried”. Checked October 7, 2026.
39. Bahar-Fuchs A, Martyr A, Goh AM, Sabates J, Clare L. Cognitive training for people with mild to moderate dementia. Cochrane Database of Systematic Reviews. 2019;(3):CD013069. doi:10.1002/14651858.CD013069.pub2 (PMID 30909318). 33 trials: “moderate-quality evidence showing a small to moderate effect of CT on our first primary outcome, composite measure of global cognition at end of treatment” and “high-quality evidence showing a moderate effect on the secondary outcome of verbal semantic fluency”; compared with alternative treatments, “CT may have little to no effect”; “we are moderately confident that CT did not lead to any gains in mood, behavioural and psychological symptoms, or capacity to perform activities of daily living”.
40. Creighton AS, van der Ploeg ES, O’Connor DW. A literature review of spaced-retrieval interventions: a direct memory intervention for people with dementia. International Psychogeriatrics. 2013;25(11):1743-1763. doi:10.1017/S1041610213001233 (PMID 23886395). “In total, 34 studies were identified, three of which were randomized controlled trials”; “spaced-retrieval training can be successfully used to teach people with dementia new and previously known face- and object-name associations, as well as cue-behavior associations”; designs and outcomes varied widely.
41. de Werd MM, Boelen D, Rikkert MG, Kessels RP. Errorless learning of everyday tasks in people with dementia. Clinical Interventions in Aging. 2013;8:1177-1190. doi:10.2147/CIA.S46809 (PMID 24049443). Review: “compared with errorful learning (EF) or no treatment, EL is more effective in teaching adults with dementia a variety of meaningful daily tasks or skills, with gains being generally maintained at follow-up”; “individuals with dementia are still able to acquire meaningful skills”.
42. Clarkson P, Pitts R, Islam S, Peconi J, Russell I, Fegan G, et al. Dementia Early-Stage Cognitive Aids New Trial (DESCANT) of memory aids and guidance for people with dementia: randomised controlled trial. Journal of Neurology, Neurosurgery, and Psychiatry. 2022;93(9):1001-1009. doi:10.1136/jnnp-2021-326748 (PMID 34667103). Pragmatic RCT: “468 were randomised to a DSP with memory aids or to usual care”; “This intervention did not maintain independence in the activities of daily living with no improvement in other outcomes for people with dementia or carers”.
43. National Institute on Aging. Do’s and Don’ts: Communicating With a Person Who Has Alzheimer’s Disease (infographic). Last updated July 22, 2026. Do: “Allow extra time for the person to respond”; “Try using different words if the person doesn’t understand what you say the first time”. Don’t: “Exclude the person from conversations”, “Interrupt or argue with the person”, “Ask the person whether they remember something or someone”. Checked October 7, 2026.
44. Folder N, Power E, Rietdijk R, Christensen I, Togher L, Parker D. The effectiveness and characteristics of communication partner training programs for families of people with dementia: a systematic review. The Gerontologist. 2024;64(4):gnad095. doi:10.1093/geront/gnad095 (PMID 37439771). “Of 30 studies (27 programs), there were 10 quasi-experimental, 5 RCTs”, with 671 family members; “Studies showed positive improvements in communication skills and knowledge, with mixed results on behavior/psychosocial outcomes”; “CPT for families improves communication outcomes, however, quality of studies varied significantly”.
45. Code of Federal Regulations, 42 CFR §410.61, Plan of treatment requirements for outpatient rehabilitation services. “The plan is established before treatment is begun by one of the following”, among them “A speech-language pathologist who furnishes the speech-language pathology services”; “The plan prescribes the type, amount, frequency, and duration of the physical therapy, occupational therapy, or speech-language pathology services to be furnished to the individual, and indicates the diagnosis and anticipated goals.” Text as published in the eCFR. Checked October 7, 2026.
46. Code of Federal Regulations, 42 CFR §424.24(c), Outpatient physical therapy, occupational therapy, and speech-language pathology services. When an SLP establishes the plan, “the certification must be signed by a physician or by a nurse practitioner, clinical nurse specialist, or physician assistant who has knowledge of the case”; “Recertification is required at least every 90 days”; “No references to an order or referral in this subsection shall be construed to require an order or referral for outpatient physical therapy, occupational therapy, or speech-language pathology services.” Text as published in the eCFR. Checked October 7, 2026.
47. Centers for Medicare & Medicaid Services. Medicare Benefit Policy Manual, Chapter 15: Covered medical and other health services (Rev. 13889, issued July 30, 2026), section 220.3. “The progress report provides justification for the medical necessity of treatment”; “The minimum progress report period shall be at least once every 10 treatment days.” Checked October 7, 2026.
48. Centers for Medicare & Medicaid Services. Speech-language pathology services (Medicare.gov). Part B covers “medically necessary outpatient speech-language pathology services”, which “provide evaluation and treatment to regain and strengthen speech and language skills. This includes cognitive and swallowing skills, or therapy to improve or maintain current function or slow decline”; “Your doctor or other health care provider (including a nurse practitioner, clinical nurse specialist, or physician assistant) must certify you need this care”; after the Part B deductible you pay 20% of the Medicare-approved amount; “There’s no limit on how much Medicare pays for your medically necessary outpatient speech-language pathology services in one calendar year.” Checked October 7, 2026.
49. National Institute on Aging. Driving Safety and Alzheimer’s Disease. “In the early stages of Alzheimer’s disease or other types of dementia … some people are able to keep driving”; “State laws vary regarding when a person with Alzheimer’s should stop driving”; “People with dementia often do not realize they are having driving problems”; signs include “Confusing the brake and gas pedals”; a doctor can be asked to tell the person to stop driving; “The American Occupational Therapy Association maintains a national database of driving specialists”. Checked October 7, 2026.
50. National Institute on Aging. Coping With Alzheimer’s Behaviors: Wandering and Getting Lost. “Many people with Alzheimer’s disease wander away from their home or caregiver”; “Make sure the person carries some kind of ID or wears a medical bracelet”; “Keep a recent photograph or video of the person to help police if the person becomes lost”; “Do not leave a person with Alzheimer’s who has a history of wandering unattended”. Checked October 7, 2026.
51. National Institute on Aging. Alzheimer’s Caregiving: Home Safety Tips. “Use brightly colored signs or simple pictures to label the bathroom, bedroom, and kitchen”; “People with Alzheimer’s may not be able to smell smoke or an unlit gas stove”; “Add safety knobs and an automatic shut-off switch on the stove”. Checked October 7, 2026.
52. Centers for Medicare & Medicaid Services. GUIDE (Guiding an Improved Dementia Experience) Model. “The model began on July 1, 2024, and will run for 8 years”; services include “care navigation, 24/7 access to a support line, caregiver training and education, respite services up to $2,500 annually, and connections to community resources”; participants are Medicare Part B providers that set up dementia care programs; the page lists 292 participants. Checked October 7, 2026.
53. Centers for Medicare & Medicaid Services. Guiding an Improved Dementia Experience (GUIDE) Model: Information for Patients & Caregivers (fact sheet). “Your Medicare benefits stay the same”; eligibility: “Medicare is your primary insurance, including enrollment in Medicare Parts A and B”, “Not enrolled in the Medicare hospice benefit or Program of All-Inclusive Care for the Elderly (PACE)”, “Not living in a long-term nursing home”, with a doctor’s referral confirmed by a GUIDE doctor; “Assessments can be done in person or virtually”. Checked October 7, 2026.
54. Medicare.gov. Hospice care. Eligibility: “Your hospice doctor and your regular doctor (if you have one) certify that you’re terminally ill (with a life expectancy of 6 months or less)”; “You accept comfort care (palliative care) instead of care to cure your illness”; “Two 90-day” benefit periods, “followed by an unlimited number of 60-day benefit periods”; “After 6 months, you can continue to get hospice care as long as the hospice medical director or hospice doctor recertifies”. Checked October 7, 2026.
55. National Institute on Aging. About the ADEAR Center. ADEAR offers “Answers to your specific questions about Alzheimer’s and related dementias” and “Referrals to local supportive services”; phone “800-438-4380 (English & Spanish, 8:30 a.m.-5:00 p.m. ET, Monday-Friday)”. Checked October 7, 2026.
56. Administration for Community Living. Eldercare Locator. “a public service of the Administration for Community Living connecting you to services for older adults and their families”; phone 1-800-677-1116, text, chat or email. Checked October 7, 2026.
57. Centers for Medicare & Medicaid Services. Telehealth (Medicare.gov). “Through December 31, 2027, Medicare covers telehealth services that you can get from anywhere in the U.S., including your home”; the examples listed include speech therapy, cognitive assessments and “Caregiver training services”; after the Part B deductible you pay 20% of the Medicare-approved amount, and “For most telehealth services, you’ll pay the same amount that you would if you got the services in person”; Medicare Advantage plans “may offer more telehealth benefits than the basic coverage in Original Medicare.” Checked October 7, 2026.
58. Centers for Medicare & Medicaid Services. Home health services (Medicare.gov). Home health care helps you “maintain your current condition or level of function, or slow your rate of decline”; covered services include “speech-language pathology services (if you meet certain conditions)”; you must need part-time or intermittent skilled services and be homebound: “Leaving your home isn’t recommended because of your condition or you have trouble leaving your home without help” and “You’re normally unable to leave your home and leaving takes a lot of effort”; “You can still get home health care if you attend adult day care”; a provider “must see you in person and confirm you need home health care”; “You pay nothing for covered home health services.” Checked October 7, 2026.
59. Centers for Medicare & Medicaid Services. Skilled nursing facility care (Medicare.gov). Covered services include “Speech-language pathology services (if they’re needed to meet your health goal)”; Medicare covers SNF care only after “a prior medically necessary inpatient hospital stay of at least 3 days in a row”; eligibility includes needing skilled care “to improve or maintain your current condition, or to prevent or delay it from getting worse”; in 2026, “Days 1–20: You pay $0 each day after you pay the $1,736 deductible”; “Part A limits SNF coverage to 100 days in each benefit period.” Checked October 7, 2026.
60. Medicaid.gov (Centers for Medicare & Medicaid Services). Mandatory & optional Medicaid benefits. “States are required to provide all mandatory benefits under federal law. States may provide optional benefits if they choose to add them through the state plan process”; mandatory benefits include home health services and nursing facility services; optional benefits include “Speech, hearing and language disorder services.” Checked October 7, 2026.
61. HealthCare.gov (Centers for Medicare & Medicaid Services). What Marketplace health insurance plans cover. “All plans offered in the Marketplace cover these 10 essential health benefits”, among them “Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)”; “Specific services covered in each broad benefit category can vary based on your state’s requirements.” Checked October 7, 2026.
62. Veterans Health Administration. VHA Directive 1170.02(1): VHA audiology and speech pathology services (December 9, 2020; amended July 19, 2022). The directive covers “disorders of hearing, tinnitus, balance, speech, language, voice, fluency, cognitive and swallowing”; “Audiology and speech pathology services are standard medical benefits available to all enrolled Veterans.” Checked October 7, 2026.
63. Brück CC, Mooldijk SS, Kuiper LM, Sambou ML, Licher S, Mattace-Raso F, et al. Time to nursing home admission and death in people with dementia: systematic review and meta-analysis. BMJ. 2025;388:e080636. doi:10.1136/bmj-2024-080636 (PMID 39778977). 261 studies; 235 on survival among 5,553,960 people: “The average life expectancy of people with dementia at time of diagnosis ranged from 5.7 years at age 65 to 2.2 at age 85 in men and from 8.0 to 4.5, respectively, in women”; median survival was “1.4 years longer for Alzheimer’s disease compared with other types of dementia”; “13% of people were admitted in the first year after diagnosis, increasing to 57% at five years”.
64. American Speech-Language-Hearing Association. Information about ASHA certification. The CCC is “a nationally recognized professional credential that represents a level of excellence in the field”; holders “have voluntarily met rigorous academic and professional standards, typically going beyond the minimum requirements for state licensure.” Checked October 7, 2026.
65. American Speech-Language-Hearing Association. Audiology and speech-language pathology certification. ASHA’s public tool lets anyone “Verify the status of an individual’s Certificate of Clinical Competence in Audiology (CCC-A) or Speech-Language Pathology (CCC-SLP).” Checked October 7, 2026.

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your individual situation.