My foster Brother is starving in an ICF nursing facility for developmental disabilities. They refuse to change from pureed food. He has had aspiration pneumonia before, but he can eat soft foods, actually better than liquid, and he enjoys eating. The new Doctor at wound care yesterday said he must have good nutrition to heal. He won't override other order from speech pathology. I am durable POA, medical and financial. What can I do?

Would it be possible to get a second speech eval? Have you been able to speak to the speech therapist, or have a three way or four way conversation with some combination of speech therapist/diet kitchen/medical doctor and yourself?
Have you had a chance to speak to the speech therapist to determine what his swallowing goals and prognosis are right now?

Has he been tried with chopped or coarse chopped level foods?

Are they attempting to manage ongoing episodes of aspirating or do they believe they can prevent it?

It really is a terrifying vicious circle, with so many potentially negative consequences. Arm yourself with as much information as you can.
Helpful Answer (1)
Reply to AnnReid

If they do not believe that he can swallow well, and it is the speech path folk who determine this, they will not give him anything with solids in it; even teeny chunks can cause aspiration into the lung, and pneumonia; this results then in antibiotics, eventually C-Diff diarrhea and the end would be/could be swift. Eventually, if you are very intent on prolonging life, and in order to supply complete nutrition you are down to the decision of whether or not to place a gastrostomy tube surgically. This is somewhat a between the devil and the deep decision as the complete nutrition delivered in this manner often causes severe diarrhea and the pressure sores will become infected. It is in fact pressure sores that go infected and systemic that often do take out those so debilitated. I cannot remember the name of the gentleman who played the last Superman, but he was injured and was paralyzed; it was pressure sores, if I am not mistaken, that finally caused him a systemic infection. The fact is that the awful sad truth is that there may not be anything that CAN be done. He is in the hands of those expert in dealing with this sort of thing and I know they have discussed with you the problems, the choices. I am so very sorry. How old is your brother? What are his disabilities? This has to be so very painful for you.
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Reply to AlvaDeer

There are all kinds of nutritional supplements on the market (boost and ensure are readily available but there are others not commonly seen outside of healthcare settings) that come in liquid and pudding forms, any competent dietitian should know what they are and how to order them. The pureed foods offered don't have to be grey and disgusting either, our nursing home even attempted pureed caesar salad (weird, but kudos for the effort!).

Just popping back to add that nobody can stop you from bringing in foods that you feel are appropriate - greek yogurt is easy and home made custards can be delicious.
Helpful Answer (1)
Reply to cwillie

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