Perhaps its because many of us have grown up associating mealtime with a sense of relaxation and enjoyment, there seems to be an overriding sense of complacency at many nursing homes when it comes feeding patients. Many facilities just dish out dispense the plastic trays of food without much regard to how– or if the meal actually gets eaten. This complacency with meal times in nursing homes is commonly responsible for situations such as malnourishment, dehydration or choking.
I began to consider the everyday complications associated with eating and drinking in nursing homes when I read about a New York Nursing Home that was sanctioned following the choking death of a patient at the facility. According to news reports, the New York Health Department issued an ‘immediate jeopardy’ sanction against Cunningham nursing home in Syracuse, NY after the agency conducted an investigation into the incident. While the specifics of the incident were not released, the conduct of the facility was obviously of concern enough for the agency to issue its most severe sanction.
Dietary Restrictions Based Upon Each Person’s Care Needs
Similar to other aspects of nursing home care, facilities must create a plan of care for every patient based upon his or her personal needs. The essential task of swallowing is something that need particular attention as it requires the coordination of more than 50 different muscles and nerves in the face, throat and chest. Patients who have experienced a stroke, Alzheimer’s or other neurological condition are most at risk for developing swallowing complications and need to be monitored on a regular basis to determine what type of dietary restrictions should be implemented.
A physician or speech language pathologist may examine the patient and conduct a series of tests to determine if there are any swallowing disorders (dysphagia) and create n appropriate dietary plan. It is then up to the nursing home staff to implement such restrictions. Depending up the individuals needs, the following dysphagia dietary levels may be implemented:
- NPO– Patients with an NPO restriction are to have nothing per oral as it is considered unsafe based upon swallowing assessments. These patients are to receive all nutritional and hydration though alternative means such as feeding tubes.
- Pureed Diet– Allowing for patients to essentially swallow foods without chewing, this diet calls for all foods to be pureed with no ‘chunks’ of food present.
- Mechanically Altered Diet– For patients who are capable of some chewing, a mechanically altered diet may contain some texture, but should be kept moist to prevent food from getting lodged in the throat. All food to should be moistened.
- Advanced Diet– For patients with slight chewing and swallowing difficulties, an advanced diet may be prescribed where the food its cut into bite-size pieces. The food should still be relatively soft and potentially difficult to swallow foods such as breads should be kept to a minimum or eaten under supervision.
- Regular Diet– A patient with a regular diet can eat any type of food and has no restrictions.
Facilities Obligation to Keep Patients Safe From Choking Incidents
From a legal perspective, facilities must carry out any dietary restrictions as they would with any medical care. When facilities either give patients the wrong foods or fail to provide necessary assistance to patients they expose themselves to liability if patients choke or become significantly malnourished. Any choking incident involving a nursing home patient deserved to be viewed with particular scrutiny as many incidents involve patients who may have gradually developed since an initial assessment by staff at the facility.
As a nursing home abuse lawyer who has worked on a number of swallowing injury and death cases, the role of facility staff acting as the eyes and ears of each patients personal physician is crucial. Hence, it is incumbent that difficulties get noted in patients’ chart and similarly relayed as they are observed. In this sense, failing to report gradual complications is no different than ignoring a physicians orders and is a potential land mine for the facility should a tragedy result.
Resource: Swallowing Disorders and TBI (PDF)