How can we balance resident requests against resident safety?

By Steve Moran

A few days ago a good friend sent me a series of screenshots from a LinkedIn group he belonged to where one of the members posted a dilemma.  

There was a skilled nursing resident who was alert, oriented and on a puree diet and thickened liquids. He likes eating and wants to be switched to a regular diet. The problem is that the resident has a long history of Aspiration Pneumonia. The facility staff has reviewed the risks with the resident and family and they state they understand the risk and are willing to accept that risk.

The Speech Therapist has, of course, recommended leaving the diet as is.   

Here is the question that was asked: “What is the risk to the facility, if he goes on a regular diet? How can I balance residents’ requests against safety?”

Very Personal

This is much more than an academic discussion for me. After my mom had a stroke and had a swallowing evaluation, the speech therapist made the same recommendation. Yet eating was one of the small pleasures that was still available to her. For us, the family, it was an easy choice. Mom got to eat what she wanted. It turned out that she did not get Pneumonia and ate what she wanted.

The Discussion

There was a lot of back and forth about how the administrator and the facility should respond. It was pointed out that ultimately the resident had the right to make a determination about what he was going to eat. I confess to being completely baffled by why there was any discussion at all. It was the resident’s absolute right to decide what to eat.  

We are providing services to adults. When those adults make decisions, we have the great privilege of supporting those decisions. It may sound cavalier but if he did die eating what he wanted . . . taking those last moments of pleasure . . . what a way to go!

The Huge Miss — Friends Don’t Sue Friends (Almost Always)

This is the perfect example of why having a consistent staff on the floor and an administrator/general manager/executive director that builds friendships with residents and family members is critical.

Friends generally don’t sue friends.

I forgive my friends slights that would completely set me off if done by a stranger. I know they didn’t intend to hurt me or insult me. I know they really have my best interest at heart. 

Too often we are just plain too busy doing reports, being important, and chasing details to take the time to get to know the people we serve. If we don’t know them, if we are not friends with them and something goes wrong, they will punish us for it.


The worst punishment, of course, is filing a lawsuit. It happens more often than we would like but is still pretty rare. The other way they punish is to not say good things about our communities to their friends . . . or even worse, they say really bad things about our communities.

This is our battle to win. They mostly want to be friends if we will allow them to be.