In long-term care, even a sandwich can be deadly

Perhaps the biggest risk posed to nursing home residents with dementia or other cognitive deficits is something rarely discussed and almost never considered harmful—food. Food products and the packaging food is presented in present significant hazards to residents who have swallowing or chewing difficulties and those who are cognitively impaired.

The Orange County Register recently reported about an incident involving an elderly man with dementia at the Anaheim Crest Nursing Center who choked to death on a tuna sandwich. The incident reportedly took place on September 9, 2008, following two other choking episodes on the same day. The first episode involved the nursing home staff inadvertently giving solid food to the unnamed resident despite the fact that his care plan set forth that he was only to receive pureed food. The second episode involved the man grabbing a sandwich from an unattended food cart.

A state investigation into the matter confirmed that the man choked to death on a tuna sandwich—the third choking incident on the same day. The investigation further confirmed that the staff at Anaheim Crest did not try to clear his throat, check him for aspiration, or provide any emergency treatment prior to his death.

The investigation comes after the nursing home initially claimed that the resident died of a heart attack. State investigators were tipped off as to the suspicious circumstances regarding the man’s death after a coroner concluded the death was related to choking.

As a result of the nursing home’s failure to follow the man’s care plan (requiring pureed foods) and the facilities failure to provide care following his choking, the facility has been fined $75,000.

Supervision is the key

Nothing can take the place of supervision. In facilities with residents who have dementia and Alzheimer’s, it is crucial the staff follow the residents’ dietary restrictions (pureed foods, no commercially packaged foods, etc.). Staff must provide assistance to ensure safety and to assure that each resident is consuming adequate nutrition and fluids.

Jonathan Rosenfeld is a lawyer who represents people injured in nursing homes and long-term care facilities. Visit his personal blog at

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