DPG11 Healthy Aging (HA)

Hello Everyone,

Wondering if anyone would be able to share their LTC facility's procedure for resident refusal of mechanically altered diets/thickened liquids, especially when MBS results indicate likely aspiration? There is some disagreement at my facility on whether or not a waiver is sufficient, if residents have to be on hospice in order to refuse, or if this simply falls in the category of resident choice/preference/autonomy?

Thanks so much!

Original Message:
Sent: 12/1/2025 7:48:00 PM
From: Anonymous Member
Subject: Procedure for refusal of mechanically altered diets/thickened liquids with significant risk of aspiration?

This message was posted by a user wishing to remain anonymous

Hello Everyone,

Wondering if anyone would be able to share their LTC facility's procedure for resident refusal of mechanically altered diets/thickened liquids, especially when MBS results indicate likely aspiration? There is some disagreement at my facility on whether or not a waiver is sufficient, if residents have to be on hospice in order to refuse, or if this simply falls in the category of resident choice/preference/autonomy?

Thanks so much!

-------------------------------------------

Hello Everyone,

Wondering if anyone would be able to share their LTC facility's procedure for resident refusal of mechanically altered diets/thickened liquids, especially when MBS results indicate likely aspiration? There is some disagreement at my facility on whether or not a waiver is sufficient, if residents have to be on hospice in order to refuse, or if this simply falls in the category of resident choice/preference/autonomy?

Thanks so much!

Hello!

From what I've learned, the term waiver typically isn't used because it doesn't hold up in court. However, a resident may decline to follow recommendations under resident rights. We have them, a witness and the provider sign an Informed Choice consent stating they understand the risks associated with not following the recommendation up to and including death. The provider then charts on the education and resident's choice in their note. I care plan it and we change the diet order.

Hello Everyone,

Wondering if anyone would be able to share their LTC facility's procedure for resident refusal of mechanically altered diets/thickened liquids, especially when MBS results indicate likely aspiration? There is some disagreement at my facility on whether or not a waiver is sufficient, if residents have to be on hospice in order to refuse, or if this simply falls in the category of resident choice/preference/autonomy?

Thanks so much!

Hello!

From what I've learned, the term waiver typically isn't used because it doesn't hold up in court. However, a resident may decline to follow recommendations under resident rights. We have them, a witness and the provider sign an Informed Choice consent stating they understand the risks associated with not following the recommendation up to and including death. The provider then charts on the education and resident's choice in their note. I care plan it and we change the diet order.

Hello Everyone,

Wondering if anyone would be able to share their LTC facility's procedure for resident refusal of mechanically altered diets/thickened liquids, especially when MBS results indicate likely aspiration? There is some disagreement at my facility on whether or not a waiver is sufficient, if residents have to be on hospice in order to refuse, or if this simply falls in the category of resident choice/preference/autonomy?

Thanks so much!

Hello Everyone,

Wondering if anyone would be able to share their LTC facility's procedure for resident refusal of mechanically altered diets/thickened liquids, especially when MBS results indicate likely aspiration? There is some disagreement at my facility on whether or not a waiver is sufficient, if residents have to be on hospice in order to refuse, or if this simply falls in the category of resident choice/preference/autonomy?

Thanks so much!