Caretaker neglect and abuse contribute to many choking deaths among nursing home residents. If a nursing home fails to protect a resident from harm, it can be held liable for the resident’s death.
Choking Deaths in Nursing Homes
Between 2007 and 2010, over 2,200 elderly adults age 65 and older died from choking on food. In 2015, more than 5,000 elderly adults died from choking, and 2,848 victims were over the age of 74. The three most common causes of death associated with choking were Parkinson’s disease, Alzheimer’s or dementia, and pneumonitis, a virus caused by inflammation in the lungs. Elderly nursing home residents with these health conditions typically require supervision and help during meals to prevent choking hazards.
Nursing homes are required to provide a safe living environment for residents and protect them from harm. For many nursing home staff members and caregivers, this means providing elderly residents with specialized care and around-the-clock supervision.
Admission Assessments
When a nursing home admits a resident to a facility, an admission assessment is done to determine the person’s overall health condition and needs. An admitting nurse performs a physical, psychological, and social assessment of the resident, including an oral assessment of the resident’s teeth and gums. The oral assessment checks to see if the resident has his/her own teeth, missing or no teeth, or full or partial dentures. This oral assessment determines whether residents have the ability to eat on their own, need help with eating, or require a feeding tube. If a resident has difficulty swallowing or is diagnosed with cognitive dysfunction, this raises red flag alerts for problems with eating.
Policies and Procedures Regarding Meals
After the admission assessment, the evaluating nurse notes a resident’s eating abilities in a file. To prevent resident injuries and deaths, notes include the type of diet needed for proper food intake and safety. In some cases, food may need to be softened or pureed, and residents may need help and supervision during meals. Notes are also made if the resident has a history of stuffing food in his/her mouth, rapid eating, stealing food, and choking episodes during meals. For residents who require assistance with meals, nurses aides and caregivers must be properly trained to identify a resident’s eating ability and ensure that the resident receives the correct meal.
Choking Risks
Due to a variety of reasons, human error accounts for a large number of choking deaths in nursing homes. Caregivers must exercise due diligence regarding a resident’s food preparation and meal plan. Serving a resident the wrong meal or food consistency can quickly result in a choking accident or death. Nursing home staff must be mindful of red flags noted in resident files that indicate problems with eating and increase a resident’s risk for choking. Such risks include:
- Inability to chew food
- Difficulty swallowing
- Forgetfulness or mental confusion
- Dementia or Alzheimer’s disease
- Parkinson’s disease
- Problems with motor skills
Nursing Home Liabilities
A rise in resident choking deaths has led to a number of quality assurance and liability issues for nursing home facilities around the country. Concerns and questions are being raised about resident assessments upon entry, staff knowledge of resident meal plans, adequate resident supervision during meals, and protocol for choking emergencies. Choking on food is an emergency that can quickly result in the death of an elderly resident without immediate treatment. All nursing home staff and caregivers should be properly trained in emergency protocol including calling 911, issuing a Code Blue, performing the Heimlich maneuver, administering CPR, and operating a crash cart.
Choking deaths are the fourth leading cause of deaths in the United States. Most nursing home choking deaths are preventable. Studies show that 86 percent of elderly adults with dementia or Alzheimer’s disease have difficulty swallowing and eating. Swallowing difficulties often cause aspiration pneumonia, a condition that occurs when food or liquid “goes down the wrong pipe” and enters the lungs. Nursing home residents with brain injuries, strokes, esophageal cancer, loose or improperly fitted dentures, and weakened muscles from old age are also at increased risk of choking deaths.
Nursing homes have a legal duty to provide a safe environment for their residents. Nursing homes must provide properly trained staff to ensure residents are monitored while eating and drinking. Staff must be properly trained in responding to choking emergencies. Although nursing homes are trained to note and recognize choking red flags, residents are often supervised by unqualified caregivers. Federal law only requires 75 hours of training for CNAs, and only about 25 states have additional training requirements. If a nursing home resident chokes to death due to improper care, neglect, or abuse, the nursing home can be found liable for the resident’s death.
