Input needed

[Lpn1997]

First off, let me say that this question if of a personal nature as it has to do with my Grandmother who is 80 years old and has Alzheimers. She is in a LTC facility but not in the Alzheimers unit. She is at the point that she no longer walks or talks, and the only response that she gives is an occasional laugh. Up until now she has been a great eater. However, in the last week she has not been eating at all...kinda like she doesnt know how to maneuver the pureed food in her mouth. So the speech therapist (not an employee of the facility, but one contracted by the facility)started working with her and decided to try syringe feeding since she determined that her swallowing ability is just fine. The syringe feeding went wonderful and the ST drew up an order for the MD to sign to continue the syringe feeding. All of a sudden, the LTC administrator contacts my mother (the POA for my grandmother) and tells her that syringe feeding is not allowed in their facility and the only option is for a feeding tube (which will never be utilized due to the living will already in place). My mother explained that my grandmother has not given up eating, she just has lost the ability to get the food to the back of her mouth to swallow. They are still refusing to syringe feed. I have never worked in LTC (I'm an LPN) so I'm not sure if this is a common problem so I thought I would check here. Is this not a form of neglect? My grandmother is 100% healthy otherwise, no hypertension, diabetes, etc. The only health problem she has ever had is a small skin cancer removed from her nose. Alzheimers is a terrible disease and I know there will be a point when she does lose her ability to swallow, but until then isn't there a responsibility to feed her as long as she is able? Thanks for any input.

[TheCommuter, BSN, RN]

Have your grandmother transferred to another nursing home where syringe feedings are a permitted part of the facility protocol.

[nckdl]

I agree, transfer her to another facility. I currently work in an Alzheimers unit as a lpn and even though it is a terrible disease she sounds like she still can eat by mouth. Good Luck

[GingerSue]

is there anything that could by substituted for the syringe,

that would accomplish the same thing?

[tridil2000, MSN, RN]

is there anything that could by substituted for the syringe,

that would accomplish the same thing?

a straw?

can she still drink?

what's the difference in drinking the tube feed than placing it into the peg tube?

pt has CONTROL.

[caliotter3]

If you can find another facility I would have her transferred. The attitude displayed by the administration at the facility where she is currently residing does not bode well for her to be treated with optimum respect. She should go somewhere where her abilities and requests are respected. They are trying to turn her into a complete invalid for the purposes of staff convenience. She deserves better.

[fultzymom]

We do not do syringe feeding at my facility either (not sure why it has never been done since before I started). If you feel this is what is required for her to keep her off the TF, I would research other facilities et get her moved to a facility that would be able to support her needs. This is true for any need that she may have.

[CapeCodMermaid, RN]

I have worked in at least 6 facilities and at no time in none of them was syringe feeding allowed. It is looked upon as demeaning and certainly could contribute to aspiration.

[nightmare, RN]

We used to use syringes but not now.The theory is that an untrained carer may syringe too fast and cause choking.

[meintheUSA]

I work with a resident in an Alzheimer faculity. She has lost the thinking pattern of eating. I am hired by family to sit with her and see that she consumes her daily need of food/fluids. Her food is pureed, and I must remind her to swallow after each bite. I have learned to encourage her to try a bite with more flavor, another bite of something different, and carry a normal conversation with her. She has just "forgotten" to chew and swallow. Our help is working, she is not on thickened liquids yet, and still enjoys her meals. Most of the time I assist with feeding her because she forgot how to use utensils. She also tires easy. This is a real joy for us, as we have become great friends.

[caliotter3]

I work with a resident in an Alzheimer faculity. She has lost the thinking pattern of eating. I am hired by family to sit with her and see that she consumes her daily need of food/fluids. Her food is pureed, and I must remind her to swallow after each bite. I have learned to encourage her to try a bite with more flavor, another bite of something different, and carry a normal conversation with her. She has just "forgotten" to chew and swallow. Our help is working, she is not on thickened liquids yet, and still enjoys her meals. Most of the time I assist with feeding her because she forgot how to use utensils. She also tires easy. This is a real joy for us, as we have become great friends.

When I worked as a CNA and had the impossible task of insuring my group of residents ate enough, I often wondered about how nice it would be if each resident who needed help with meals could have a personal caregiver for this task. I took 40 minutes with one of my charges one day. She ate 95% instead of the usual 0% or 5% that the CNAs always listed for her intake. I remember telling the charge nurse about this and we discussed it. From that time forward I took extra time with her. Unfortunately, you can't spend your entire shift on feeding. I think you have a great job. If I were working as a CNA, this is what I would like to do.

[achot chavi]

I have worked in at least 6 facilities and at no time in none of them was syringe feeding allowed. It is looked upon as demeaning and certainly could contribute to aspiration.

I agree however tube feeding is worse. WE don't allow syringe feeds, but if families want to do it we discourage it but have them sign responsibility. We teach them to allow only 15cc at a time and wait for the swallow etc.

Syringe feed is proven as contributing to aspiration but so it tube feeding.

If this was my grandmother, I would try to syringe feed carefully. If the facility didn't allow it and I couldn't arrange family attendance at every meal, I would transfer her.

This is such a personal issue.... Good Luck, and G-d Bless