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Choking is one of the most common causes of injury and death in nursing homes across the US. National Safety Council data shows that over half of choking deaths are in people older than 74, and over 5,000 people die from choking each year.

Sadly more often than not, these injuries are preventable and are caused by neglect and many of these incidents lead to death.

If you’re struggling to understand why your loved one was hurt, or you’re worried about a choking injury at an Arizona nursing home, here are some steps you can take.

Why are choking incidents so common in nursing homes?

You have probably experienced minor choking before and understand how shocking and painful it can be, even for a healthy person with no added risk factors.

Most nursing home residents are at greater risk of choking due to both age and other underlying health conditions. All nursing homes should have staff supervising meal times, so choking incidents can be prevented or immediately remedied.

There are many reasons why choking nursing home accidents happen, but most of them point to a lack of due diligence when it comes to individual resident care.

Cause of choking: human error and negligence

Nursing homes are legally obliged to offer safe and effective care to each and every resident based on a comprehensive care plan. This can be difficult and unfortunately doesn’t always happen, for reasons ranging from improper staffing to a lack of documentation in care plans to general negligence

Here are a few things that can lead to negligence and choking or other injuries:

  • Lack of training
  • Lack of adherence to care plan
  • Lack of supervision
  • High staff turnover
  • Lack of staff members
  • Poor training
  • Poor communication of care plan

Nursing facilities should have a specific dining area and plenty of staff available and watching residents at all times.

Negligence may happen because it can be difficult for staff to understand exactly the different types of care resident’s need unless they are directly involved in the care plan of a specific resident.

Choking prevention and emergency response

Two crucial aspects of reducing choking-related injury and deaths include prevention and emergency response.

During the initial health assessment which is the basis for the first version of the care plan, an oral assessment should take place. The oral assessment will include:

  • Whether the patient has teeth
  • Partial dentures or full
  • Oral cavity inspection
  • Swallowing assessment

As the care plan is established, it will also include information about eating routines, including whether the resident needs encouragement (for instance) or has a tendency to steal food.

Typically there is a tray ticket that goes along with each meal preparation plan so that everyone involved in meal planning, serving and feeding has the information clearly in front of them.

Any added protocol in the meal service process which can reduce the risk of choking should be incorporated into the care plan.

Because death from choking can happen so quickly, all staff members should also have relevant, updated training on the most effective emergency response procedures.

Heimlich maneuver training, CPR training, and clarified processes for accessing emergency care. For instance, staff may want to use a term such as “code red” to ensure a fast response from the rest of the staff. (Source)

What health problems put seniors at a higher risk for choking?

Elderly residents who have difficulty swallowing will be more at risk of choking, but what makes seniors so susceptible to health issues that can impair swallowing?

Unfortunately, Dysphagia (difficulty swallowing) is par for the course for most people as they age. As the entire body slows down in response to muscle weakness and other normal symptoms, so do the muscle reflexes which control swallowing.

Added to this decrease in function is that seniors are more susceptible to many ailments and other health conditions, which can make swallowing more difficult.

Here are some common health issues which put seniors at a higher risk of choking injuries.

  • Cognitive Impairment: Alzheimer’s and dementia are common reasons for limited brain function and mobility in the elderly. Sometimes this means they do not have the coordination to cut their food properly or to feed themselves in a safe manner.
  • Problems with Dentures: Missing teeth, improperly fitted partials or a lack of dentures will affect a person’s ability to chew food well, increasing the risk of choking.
  • Muscle Spasms and Muscle-Related Disorders: Stroke, Cerebral Palsy, Multiple Sclerosis, and ALS are just a few of the illnesses which can affect coordination and muscle control in any part of the body.
  • Acute Illnesses: Flus, pneumonia, and even colds can impair a resident’s ability to swallow or eat.
  • Stroke: Stroke impairs muscle function at a number of levels, and can also affect brain function.
  • Less Saliva Production: Saliva lubricates the food passage for swallowing. Saliva production often decreases in old age, either naturally or due to other reasons. Medications which cause dry mouth or other issues which may lead to dehydration can worsen this problem.
  • Illnesses Affecting the Stomach: Seniors may experience a higher frequency of stomach upset and digestive problems due to weakening swallowing and digestion, medication, difficulties eating and a change of diet. Examples include celiac disease, diverticulitis, and acid reflux.
  • Cancer: Cancer-related health problems such as scars, radiation, or chemotherapy can also make  swallowing more difficult.
  • Aspiration Pneumonia: This is a type of pneumonia which happens if food or liquid is inhaled. It is usually caused by breathing while eating or fast eating or drinking. The elderly are more prone to this type of infection because their lungs sometimes lack capacity to expel foreign substances.
  • Problems to Do with the Neck and / or Esophagus: Thyroid problems, surgery, smoking, arthritis, and bony protrusions are all examples of problems which can affect the area around the esophagus and interfere with swallowing.

Dietary planning and the care plan

A care plan is a detailed documentation of a residents’ health needs, and it should focus on dietary requirements, including their chewing and swallowing ability.

Denture care and tooth care are two other areas which should be addressed in the care plan, as they can be related to choking incidents.

All of their care team should be aware of specific needs for each resident that they are responsible for.

Examples of gaps in the care plan and mistakes that can happen around food and diet if the care plan is underdeveloped or ignored include:

  • Feeding a resident the wrong food
  • Feeding a resident food that is the wrong consistency
  • Eating alone in room and unsupervised
  • Requiring assistance to cut up food
  • A lack of emergency response system if the resident is allowed to eat in the room
  • Neglecting to coach the resident to chew and eat slowly

To reduce the risks of such mistakes, a care plan may contain specific requirements, such as including thickening agents in foods so that they have the desired consistency, pureeing food, or cutting food.

What are the consequences of choking incidents?

When an object is lodged in the throat, it can cut off the airway partially or completely, cutting off oxygen flow to the brain and contributing to brain damage or death. This can happen in the space of only a few minutes.

Legally, the consequences of choking injuries depend on whether or not the nursing home facility is proven liable for an injury or wrongful death.

Federal inspections and compliance inspections will take into account diet and eating habits per the care plan per federal (CMS) standards. Homes will get health citations and the CMS can revoke a care facility’s funding as well as fine them if a home is out of compliance with federal standards.

Unfortunately, Many incidents go unreported, and the CMS doesn’t always hold nursing homes accountable for substandard care.

Examples of mistakes that could lead to legal action include:

  • A nurse forgets to put in dentures, then feeds a resident something like a sandwich, despite the fact that his care plan specified pureed food.
  • A resident was left to eat food alone in his room, despite the fact that his care plan says he needs supervision at all times. As he began choking, he hit the call button and there was still no response.
  • Residents who are eating in a supervised area but are non-verbal or not able to move and therefore cannot alert staff if there is a problem need extra supervision.
  • Several small choking incidents occurred and staff was there to help. However, these incidents weren’t reported and recorded on the care plan. The choking was a symptom of a worsening problem with a tumor in the throat which continued to grow unnoticed.

Signs that a resident may be at high risk

Indicators that a person may have trouble swallowing their food include:

  • Coughing
  • Gagging
  • Throat clearing
  • Painful expression during meals
  • Drooling
  • Hoarseness
  • Toughest their throat
  • Frequent heartburn
  • Refusal to eat or drink

Often, one medical condition or choking incident is an indicator of other problems.

A nursing home care team should be in the lookout consistently for issues that might put someone in a higher risk category, and adjust the care plan accordingly.

If your loved one is in a care home, you should be aware that choking is a possible problem. Check to see that your nursing home has a proper medical emergency plan and people are trained to handle choking emergencies.

If you are eating with a loved one at a care home, be sure you let staff know if there has been a choking incident, as this can lead to other issues like aspiration pneumonia, a lung infection which results from inhaled food or liquid.

Call a nursing home abuse lawyer for more information

Choking is just one thing that puts nursing home residents at risk, and there is no good reason why residents should be at risk of any preventable injury while in long-term care homes with skilled medical professionals.

A suspicious “accident,” a breach of trust or unusual behavior at a nursing home should always be investigated.

If you are not confident that your loved one is in the best care, or there has been an injury or death while in the care of nursing home staff, you may be entitled to compensation.

We can help you find peace of mind and guide you through the proper reporting and settlement process. Call one of our qualified, compassionate attorneys to learn more about filing a claim today.

Choking in nursing homes FAQs

What are the main causes of choking? 

Seniors are susceptible to a variety of health problems which put them at a higher risk for choking. When this is combined with negligence in a care home, a loved one may be in danger of choking-related injuries.

How can you tell if a nursing home choking incident is an accident or neglect? 

Unless staff owns up to a mistake, it is not going to be easy to know whether a choking incident is a genuine accident. A qualified nursing home attorney will work with other governing bodies on your behalf to investigate incidents.

If my loved one had a choking incident, are they entitled to compensation?

If evidence exists that the nursing home management or staff was at fault for a choking incident, you may be entitled to compensation.

Who should I contact if I suspect choking or other forms of neglect or abuse?

In Arizona, there are four key offices who are in charge of long term care certification, complaints, investigations and reporting.

They are:

Our experienced attorneys offer comprehensive guidance on all personal injury matters by phone or video conference call.

Our team of lawyers work closely with their injury clients across Arizona, communicating clearly whilst offering reassurance and empathy through an often very difficult and emotional process. During the free consultation, our lawyers will discuss your concerns before creating a comprehensive plan for you, while also assessing the strength of your claim.

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