A woman called me today. Her husband, age 95 years, lives in a Toronto Nursing Home receiving round the clock senior care, and yet she rightfully fears for his comfort, safety and well being. Her husband suffered a stroke and as a result has difficulties swallowing safely. The speech-language pathologist who assessed him in hospital gave specific direction about how to prepare his meals; the food should be minced and the fluids should be thickened. The patient, now living in a Nursing Home, has a sign over his bed that reminds staff about how to safely give him food and fluids.
This is the incident that the caller relayed to me: She arrived at the Home at 5:20pm and found her husband lying down flat in bed, he had vomited and was now coughing and gasping for breath. His colour was poor. She raised the head of his bed and waited for the coughing to subside, she called the Nurse to come to the bedside. The Nurse confirmed that she had fed the husband, she had not noted any difficulties.
So what’s wrong with this picture?
The wife noted that feeding her husband safely is time consuming and takes some degree of patience and skill. It could not have been accomplished in 15 minutes. Also, the patient should not have been left lying in a flat position, without his head elevated, immediately after eating. The patient would be at high risk for aspiration pneumonia.
What to do? The floor has 38 high need residents, but only 3 Personal Care Assistants, 1 Registered Practical Nurse and 1 Registered Nurse. The wife visits with her husband daily and feeds him but cannot be present for every meal.
The patient’s wife, understandably, is frantic with worry. She is making inquiries with her insurance company to see if additional services can be covered. She is trying to involve the Home’s doctor. She is trying not to alienate the Home’s staff – but she has already had angry words with them and talked about suing them for poor Practice.
My advice: Have a conversation immediately with the Nurse in Charge, report the incident, express your concerns. Get a commitment from the Nurse that a care provider will be dedicated to assist the patient during mealtimes. Ask the Nurse to reinforce the direction of the speech-language pathologist with all of the staff. Document the incident, document your conversation. Send a copy to the Nurse in Charge, to the Home’s doctor and a copy to the Director of Nursing. I recommended putting together a schedule and assigning who it is who will feed the patient; the wife, staff, a paid caregiver, even a Nursing student completing a practicum, if appropriate.If the wife is not satisfied with the response of the Home and does not see an improvement in the way her husband is cared for, she can contact the Ministry of Health, Long Term Care and make her concerns known. Finally, she may want to consider a transfer to a Home where she has more confidence in the quality of care provided.