Nursing Home Resident With Swallowing Disorder Chokes To Death

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A Danbury nursing home has been fined $1,040 by the state in connection with the death of a resident who choked on a meatball.

The state Department of Public Health imposed the fine against the Danbury Health Care Center on March 12 after the January choking death.

The state’s review found that medical and treatment records of the resident, who had cancer and a seizure disorder, failed to reflect that the resident was at risk for dysphagia – or difficulty swallowing. A diet order indicated the resident should receive a regular diet, with meat cut up, with thin liquids, state records show.

On Jan. 27, a licensed practical nurse placed the evening meal tray on the bedside table in front of the resident and did not uncover or set up the meal, records show. The nurse then returned to a medication cart outside the room to prepare the resident’s medication. The nurse reported returning to the room and finding the resident unresponsive, records show.

The meal tray had remained covered, and no food was visible in the resident’s mouth, records show.

The resident was hospitalized, and the hospital reported that a meatball was removed from the resident’s airway, records show. The resident died the next day, and DPH records list the cause of death as aspiration leading to hypoxic encephalopathy – a lack of oxygen to the brain.

The home’s food service director told state investigators that the kitchen staff was not responsible for cutting up meatballs or meat for residents, records show. The meatballs served with spaghetti that night were served whole at about three-quarters to 1 inch in size, and they were considered appropriate for a soft diet, records show. The licensed practical nurse who delivered the tray said the resident’s risk of difficulty swallowing should have been noted in the resident’s evaluation form, records show.

State officials raised concerns about choking deaths in Connecticut nursing homes in 2012 and 2013 when DPH cited and fined at least five nursing homes in cases of residents who had choked on food. In some cases, DPH found that nursing home staff members had been negligent in their care of residents.

The Danbury home’s administrator could not be reached for comment.

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