The Diet Waiver Alternative: How to Advocate for Patients’ Rights

1. The Right to Decide

We discuss the Patient Self-Determination Act, what it means for patients and residents as they direct their own care, and the requirements of care providers. Discussion includes the possible penalties if we do not follow the law.

2. Safe Swallowing and Pneumonia

We describe the science behind the development of pneumonia. This provides the clinician with necessary knowledge to participate in discussions with the medical team about the reality of the relationship between aspiration and potential for negative consequences.

3. Linking Legal and Clinical, Part 1

Individuals who have served as expert witnesses describe their experiences. We learn about cases that have come to litigation, the task of being an expert witness, and observations these individuals made about case management and documentation.

4. Linking Legal and Clinical, Part 2

We interview Michael Hill, an elder attorney, who shares his observations and insights on cases that come to litigation. He describes the importance of following the process of informed consent to demonstrate that patients/residents have been able to participate in their own care. We also discuss the problems with waivers and the necessity of documentation of conversations.

5. From Information to Conversation

Learn how to have nonbiased conversations in team meetings so that patients/residents and their families can receive the information they need to make informed decisions. We provide simulations of both biased and nonbiased conversations.

6. Administrative Challenges

It can be difficult for a clinician to navigate change in the facility if administrative staff are reluctant or fearful. We discuss the importance of having open conversations, addressing the priorities of the specific listener, recognizing the source of their reluctance, and ensuring that the clinician approaches the conversation with full preparation of theory and patient-specific information.