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SAN FRANCISCO, CA — October 29, 2004 — Fourteen California residents died from improper tube feeding in state nursing homes from 2003 through August, 2004, according to a press release by California Advocates for Nursing Home Reform (CANHR). The group based its figures on California Department of Health citations, which included 23 instances of dehydration, hypertension, infection, respiratory and renal failure. The problems spanned 14 counties.
The feeding tube citations at the California nursing homes indicated “a lack of skill or attention on the part of licensed staff,” according to CANHR. Some feeding tubes were not inserted properly or were removed without a doctor’s orders. Also, nursing home personnel did not always check or clean the feeding tubes properly.
A feeding tube provides nourishment to a person who cannot swallow or take in adequate amounts of food by mouth. Usually, the feeding tube is inserted through the stomach. This is called a percutaneous endoscopic gastrostomy tube (PEG). Feeding tubes that are inserted through the nose and into the stomach or the small intestine are used less often.
Whether doctors prescribe feeding tubes for nursing home residents may depend on factors in addition to health considerations. One study showed a state–by–state difference in the prevalence of tube feeding, ranging from 7.5% in Maine to 40.1% in Mississippi (J Am Geriatr Soc. 2001 Feb; 49(2): 148–52). Another study, which involved 186,000 residents in 15,135 licensed nursing homes nationwide, found that those patients who were cognitively impaired, nonwhite, male, and lived in for–profit facilities, had the highest rate of feeding tube use (JAMA. 2003 Jul 2; 290(1): 73–80). These patients also had not left advanced care instructions.
Many groups believe that whenever possible, spoon feeding is a kinder, better way to treat patients who are not able to feed themselves. The Alzheimer’s Association Ethics Advisory Panel has criticized tube feeding and said that “assisted oral feeding should be available as needed to all persons with advanced Alzheimer’s.”
Spoon feeding requires a dedicated staff with enough time to sit with and assist impaired residents. Unfortunately, however, understaffing is the norm in many nursing homes, providing a financial incentive that may encourage tube feeding even when it is not necessary. See Nursing Home Abuse: Why Does It Exist?, particularly the section on understaffing, for more insight into the causes of inadequate care in nursing homes.
Brayton Purcell is concerned with the well–being of our seniors, both in nursing homes and in the community. We represent victims of elder abuse, nursing home abuse, and neglect. We also deal with cases involving inadequate pain management. If you have a question about the legal rights of an elderly loved one, please feel free to contact us.
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