Managing Choking Risks at Residential Care Facilities

Choking is a surprisingly common cause of death. It’s not just children who are at risk, either – people of any age may succumb to choking. Older adults may have health conditions that make them particularly vulnerable. Residential care facilities should protect their residents and reduce their liability by proactively managing choking risks.

A Leading Cause of Unintentional Injury Death

According to the National Safety Council, choking is the fourth leading cause of unintentional injury death. People who have difficulty swallowing, use dentures, or are over age 71 are at a higher risk.

There have been many news stories involving choking fatalities at residential care facilities:

• A 77-year-old man at an assisted living facility in South Carolina choked to death while eating in the dining area of the residential center. According to The Post and Courier, the man’s daughter has filed a wrongful death lawsuit, alleging that the facility did not do enough done to assess the risk of choking, prevent the choking death, or provide reasonable care.
• An assisted living facility offering dementia care has been found negligent in the choking death of a resident, according to ABC 6 News. A report from the Minnesota Department of Health says the resident’s doctor had ordered the facility to cut food into small pieces after a previous choking incident, but there is no evidence that this was communicated to the proper staff.

While these are worst case scenarios, they illuminate the need for proactive risk management. Here are four key steps.

Step 1: Assess Resident Risk

Resident risk assessments should include an evaluation of choking risks. As a resident’s risk level may evolve over time, it is necessary to reassess the risk level after a change in health. Some things to consider include the following:

• Difficulty swallowing
• Use of dentures
• Medication that may interfere with swallowing
• Dementia
• Previous choking incidents and near misses, even if they seemed minor

When in doubt, refer residents to their healthcare providers for an evaluation.

Step 2: Communicate and Follow Doctors’ Orders

A resident’s healthcare provider may issue orders regarding safe food. For example, a doctor may put a resident on a puree diet or say that food needs to be cut to a certain maximum size. It is important to communicate these orders with your staff. Noncompliance with mechanical soft diet, puree diet, or food size restrictions could result in choking. Learn more about specialized diets for Senior Care.

Step 3: Provide Supervision During Mealtimes

Proper supervision during mealtimes is important in case any residents begin choking or have another type of medical emergency. The staff providing supervision should have access to resident information regarding choking risks and doctors’ orders to ensure they know what to watch for. They should also actively monitor the dining area.

Step 4: Train Team Members to Spot and Respond to Choking

It’s important to understand that people who are choking will not always be coughing or making noise. In fact, serious incidents are often quiet. According to the National Safety Council, if a person is coughing forcefully, you should encourage him or her to continue doing so, as this is a good way to clear the object. However, a person who cannot cough, speak, or breathe is in serious danger and needs immediate help. If the person is:

• Responsive, perform the Heimlich maneuver and call for medical attention.
• Unresponsive or becomes unresponsive, remove any objects from the mouth, provide CPR, and call for medical attention.

If the person recovers before emergency medical services arrive, medical attention is still necessary. The resident may have inhaled food, which could result in aspiration pneumonia. Injuries are another possible complication, including injuries to the throat as well as to the ribs after the Heimlich maneuver or CPR. Even if the person seems fine, a medical evaluation is vital.

One Final Consideration: Residential Care Facility Insurance

Choking risks increase with age and health problems. Even if your facility does everything correctly, it’s possible a resident will experience a fatal choking event. If that happens, you could face accusations of negligence. Adequate documentation and residential care facility insurance will support your defense. Tangram offers residential care facility insurance through the Personal Care & Assisted Living Insurance Center (PCALIC). Learn more.