eating while reclined

[messier]

The nursing home have just phoned me today to say that although the OT has told them to feed mum when she is reclined for her comfort, they won’t do that because their guidelines are that people should be upright. They are even telling me that when I feed her I can’t do it because they could be accused of manslaughter even though mum has been very clear that she wants to eat reclined, and I’ve said I’ll sign a disclaimer. Has anyone got SALT or GP or neuronurse to say that feeding reclined is OK if that is the patient’s wish?

[JMDean]

SLP here. Eating and reclined position does significantly increase risk of aspiration (and possibly choking). Do you have more information about why the OT would’ve recommended that? Often OT’s have swallowing training so there could be a logical reason but on the face of it, we are generally opposed to having people lying back, because it adds a dangerous component to swallowing. See if you could get the OT to produce of a comprehensive set of guideline instructions for mealtimes , and perhaps even a picture or graphic it or two in order to educate the facility. Otherwise, I think you may continue to get resistance.

[messier in reply to JMDean]

Thanks. The OT recommended it because she understands the postural problems that mum has that mean she can’t sit upright comfortably. Given that she is only taking a half teaspoon of thickened liquid at a time the risk from any spoonful is small. Mum gets coughing fits as much if not more when she is not eating, just from saliva. She currently still has a good cough reflex and can cough hard. Of course there is a risk of aspiration. It’s the most likely thing to take her. She knows that. But she’s 89, has to be hoisted, only has movement in one hand that can’t even work a TV remote, can’t read books, and struggles to find words, and bluntly at this stage should be allowed to get what pleasure she can from food rather than finding the process uncomfortable. The home are more interested in protecting themselves than recognising that this situation is allowed for in law.

[JMDean in reply to messier]

well, if it was an OT, I’m presuming that they’ve done all of the different approaches they have in their toolbox to improve positioning, which would be my first suggestion. However I wonder if she is able to get enough calories in each day to maintain her weight. If she’s getting supplemental nutrition from a tube, perhaps there’s a way to ask for a doctors order for “pleasure feeding“ which is not geared towards nutrition as its primary goal. I still think you’re going to get a lot of pushback because much of swallowing is gravity-related, in conjunction with air pressure caused by closure of the lips, the soft palate and other structures, all of which are going to be compromised by a reclined position. I agree with others, who have recommended another evaluation from the speech and language, therapist, optimally in collaboration with the OT. however, I recognize that this is not a quick and easy solution so you’re going to have to brainstorm with your clinical care team a bit.

[Kelmisty]

I haven’t heard of this one but in my logical side, surely eating reclined increases the chance of choking? Which as a business you would want to reduce?

Why would the OT recommend this without the SALT specialists involved?

Maybe if they have it in writing from the SALT and GP they maybe more open to it? It’s a difficult one, but surely you are ok doing it as they have offered you advice and you can as you say sign a disclaimer against it. It’s not like you are going to sue them as you know the risk of choking with this illness.

I do think at times the world has gone a little risk crazy.

[45purple]

Never heard of that and I worked in a care home for 10 years. I understand what you’re saying about the position your mum is in with her back etc but I would ask for the SALT to access your mum again. 💜💜

[Dance1955]

no way never I wouldn’t do it I was always told to sit my husband upright it makes sense sorry I wouldn’t be doing it

If they have a tilt wheelchair it’s easy done maybe if mum is in bed they can’t be bothered sitting her up good luck with it all

You know best you’re the carer and mum probably is not really able to make her own decisions if she has PSP or CBD do they even know what it is ?

Sorry I wouldn’t trust them they just want an easy time

If she’s coughing you may need to give her atropine drops half an hour before he feed it helps it actually am eye drop but is widely used for helping with Sylvia just a couple of drops under the tongue 2 or 3 times daily before food trust me they eat much better with it I used it for my husband and really it’s all about the quality of life now isn’t it ?

Hugs to you we know more on here than nursing homes go with your gut

Xx

[OllieFisher1]

I am with you on this one......comfort is paramount with this disease and more important if your in the resthome stage. If you cannot eat comfortably there is not much left. My father eats reclined sometimes (not all the way down).........it might cause aspiration but if thats how hes happiest and most comfortable, then so be it.

[messier in reply to OllieFisher1]

Thanks OllieFisher1 that’s what I am trying to get the home to understand

[Martina_MP]

She doesn’t need to be all the way up, but it is reasonable to try for the most upright sitting position that her comfort allows, with a tilt-in-space wheelchair, recliner, raising the head of the bed, pillows etc. Given how my mom tends to have her head hanging forward, I tilt her back a bit to get the food into her mouth and not have it fall out immediately. If you can change her mealtime position a few degrees up from her usual resting position, maybe they will accept that.

[messier]

Thanks MartinaMP - it’s about 45degrees in her reclining chair that we are asking for. Mum’s head is only slightly tilted normally, but being tipped back certainly helps. Interestingly I’ve been reading around and found quite a bit of evidence that a partly reclined position like this is actually better in neurological disease!