There actually are many success stories related to residents exercising their choice to eat real food when they have swallowing problems. Having to eat pureed foods or thickened liquids can make residents feel as if they have been stripped of the last vestige of civilization, social normalcy, and dignity, so it isn’t surprising that they often fight to eat the way they want.

However, as Bowman notes, there are ways to compromise. For example, she says, “If someone wants to eat real food, you can ask, ‘Would you be willing for us to cut it up in little pieces?’ Very often, they will welcome that.”

In instances where, after much discussion, the resident basically says, “I am willing to take the risk of choking and dying,” Bowman suggests having the person sign a document to that effect. She also recommends having the family and other team members at the table to hear the resident say it.

When the facility communicates with residents and gives them an opportunity to share their feelings, everyone can be comfortable with the result. Consider a story Bowman tells. An 82-year-old resident had a stroke. She was unable to speak clearly or feed herself. Her physician recommended a feeding tube to prevent aspiration. The resident, who was still mentally alert, said no. Her sister and power of attorney supported the resident’s decision. Afterward, the woman was hand-fed pureed food. She eventually died of aspiration, but not for several years.