Failure to Honor Resident Choice in Diet Texture
Penalty
Summary
A resident with multiple complex medical diagnoses, including ALS, dysphagia, and recent dental procedures, was admitted to the facility and subsequently placed on a pureed texture diet. The hospital discharge summary recommended a soft diet for an unspecified number of days following a dental procedure, but did not indicate a need for a long-term downgrade in diet texture. Despite this, the facility maintained a pureed diet order for the resident without documentation of appropriate medical tests or assessments, such as a modified barium swallow study, to justify the continued restriction. The resident, who was cognitively intact, repeatedly expressed dissatisfaction with the pureed diet and requested to revert to a regular texture diet, but there was no evidence that the facility offered this option or documented informed refusal with acknowledgment of risks. Interviews with the resident confirmed that he refused facility meals due to the pureed diet and had to purchase his own food, as no alternatives were provided. Staff interviews, including those with the dietitian, SLP, and LPN, confirmed that the resident was only offered pureed food and that changes to the diet order were contingent on further swallow studies, which had not been completed. The facility failed to honor the resident's right to self-determination and choice regarding diet texture, as required, by not facilitating or documenting the resident's informed choice to assume risk and select a different diet texture.