• Chronic lung disease (COPD, bronchiectasis, cystic fibrosis)
• Cigarette smoking
• Dementia, stroke, brain injury, cerebral palsy or other brain disorders
• Immune system problems (during cancer treatment, or due to HIV/AIDS, organ transplant or other diseases)

• Other serious illnesses, such as heart disease, liver cirrhosis or diabetes
• Recent surgery or trauma or surgery to treat cancer of the mouth, throat or neck
• Inadequate oral care
• Increasing age
• Poor functional status

• Dementia
• Co-morbid conditions
• Male gender
• Swallowing difficulty
• Inability to take oral medications
• Medications such as anti-psychotics, anticholinergics, H2 receptor blockers and proton pump inhibitors

In the pre-admission process:

• Do you have a listing of services/capabilities to ensure your facility meets the specific acuity level of the patient or resident?
• Are the hospital discharge instructions complete and include advance directives?
• Does your facility have a process in place to ensure readiness for admissions?

In the post-admission process:

• Are you doing quality rounding for at least the first seven days? Is upper management involved?
• Are clinical staff up-to-date in their assessment skills and continuing education?
• Are you using Situation, Background, Assessment, Recommendation (SBAR) or an equivalent system to ensure proper/informed communication?

In the discharge planning process:

• Are you starting the discharge process upon admission? Is it interdisciplinary?
• Are you properly discharging patients and residents with clear/concise instructions?
• Is social services completing a post-discharge follow-up to ensure patient or resident well-being?