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Risk Management: Clinical Areas of Liability - Nutrition and Hydration

Risk Management Health and Nutrition

Frequently, the elderly show less interest in eating. Additionally, they may also stop drinking as much. Although the actual prevalence of malnutrition and dehydration is not known, dehydration remains the most common fluid and electrolyte disorder among the elderly.

Weight loss can become quite noticeable, and if there is extreme weight loss, artificial nutrition or hydration may be considered. Potential areas of liability include:

  • Unexplained weight loss
  • Failure to consult family members regarding intervention for weight loss (including feeding tubes
  • Worsening of a pressure ulcers or infection because of a malnourished or dehydrated state

In order to avoid possible areas for litigation, LTCs and other facilities caring for the elderly should take the following steps:

  • Identify residents with poor oral intake
  • Construct realistic care plans
  • Include family members in setting goals for residents in whom nutrition and hydration are an ongoing challenge.
  • Provide advance directives regarding artificial nutrition and hydration early rather than waiting for crisis situations

Dysphagia (swallowing dysfunction), a frequent condition in late-stage dementia or after stroke, can present a challenge for staff when it comes to the need to provide adequate nutrition and hydration without the use of a feeding tube. Early assessment by a speech/language therapist, planning by the facility dietitian, and adequate staff assignment is necessary to avoid weight loss.

Key assessments include:

  • Accurate weights and determination of caloric intake
  • Documentation in the medical record of food and fluids
  • Documentation of physician notification of significant weight loss or poor oral intake
  • Documentation of family notifications, discussions, and decisions
  • Review of any tube feeding formula by the physician and dietitian for adequacy caloric content

Before considering alternative methods of nutrition and hydration, certain questions need to be asked:

  • Has there been a swallow study (Modified Barium Swallow) done to rule out a physical problem which makes swallowing difficult?
  • Are ill-fitting dentures or poor dentition to blame for a decrease in eating?
  • Is there a fear of drinking or eating because of problems with incontinence?
  • Is depression a factor?
  • Are medications to blame?
  • Is dementia a factor?
  • Is a decrease in appetite the result of a terminal illness?

If alternative means of nutrition and/or hydration are deemed necessary, the following questions should be considered:

  • Will patient’s nutritional status improve?
  • Will there be a decrease the risk of disease or will disease be prevented?
  • Will there be an increase in life expectancy?
  • Will there be an improved the quality of life?
  • Is this a short-term or long-term intervention?
  • What are the risks involved?
  • Are there any other considerations?

All of these questions and their answers must be considered very carefully before pursuing alternative means of nutrition. Additionally, before providing alternative means of nutrition, the medical staff of the facility must educate patient families on the benefits and contra-indications of such provision.

Highland Risk Services understands the need to make sure all those involved in the care of the elderly do so with professionalism. Our programs help protect against the exposures faced by elderly care facilities as they continue to assess their ability to provide quality care. Please call us at one of our two offices in Chicago at 847-832-9100 or Lansing at 517-676-7100 for further information about our programs.

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