A sizable contingent of the nursing home population has difficulty swallowing due to a variety of medical conditions including stroke, muscle weakness and Alzheimer’s. Diagnosing patients with swallowing problems is part of the nursing homes overall responsibility when it comes to patient care. While a series of sophisticated swallowing are now available to assist in the diagnosis of swallowing problems — such as an X-ray with a contrast material (barium X-ray) or A visual examination of your esophagus (endoscopy), most facilities rely upon an exam conducted by a physician or speech therapist with specific training regarding swallowing. After the patient has been assessed, the patient’s physician will assign restrictions based upon the patient’s abilities. A doctor will write an order for the type of diet– and food consistency that a patient requires: whole, chopped, pureed, liquid or even the use of a feeding tube in some cases. Just like any other order from a doctor in a patient’s chart, the nursing home staff are to adhere to the order until otherwise instructed. However, just as with any medical complication, nursing home staff need to be present to monitor patients and provide assistance when needed. Primarily when staff fail to abide by standing orders or when staff fail to monitor patients during meals, patients with swallowing problems are at risk for serious life threatening complications due to choking. I was reminded just how serious choking episodes in nursing homes can be when I read about how three nursing home patients in Connecticut nursing homes have choked to death over the course of the last three months! These terrifying incidents include:
- On April 29th, a developmentally disabled patient at Meridian Manor nursing home choked to death on ziti procured from a take-out restaurant that actually delivered the food directly to the patient’s room without any intervention from facility staff.
- On March 6th, an 82-year-old patient at Aurora Senior Living Center in Cromwell choked to death on marshmallows.
- On February 3rd, a patient at Torrington Health and Rehabilitation Center choked to death on a peanut butter sandwich despite be on a highly restrictive diet that outlawed solid foods.
As a witness to choking incidents in the legal context, I find these incidents among the most troubling as they almost universally stem from the fact that the nursing home staff are not following the medical orders or are simply not providing necessary supervision. Indeed, while any patient can have an episode of choking, it remains the responsibility of nursing home staff to keep an eye on patients and provide necessary intervention when necessary. As with other complications arising in the nursing home setting, staff have a relatively short window of time to act. Patients who have food caught in their windpipe must have the food removed within minutes or they risk serious brain damage or death.