Ask Proactive – We recently had a resident who experienced a choking episode during lunch. Staff performed the Heimlich maneuver successfully, and a swallowing evaluation later showed they had difficulty managing regular-texture foods and thin liquids. What should be included in the care plan for a resident who has experienced a choking event or is at risk of choking?

Q:

We recently had a resident who experienced a choking episode during lunch. Staff performed the Heimlich maneuver successfully, and a swallowing evaluation later showed they had difficulty managing regular-texture foods and thin liquids. What should be included in the care plan for a resident who has experienced a choking event or is at risk of choking?

 

A:

The care plan should reflect the resident’s real experience, risks, preferences, and personalized interventions including the following:

The Problem/Need/Focus should avoid generic language and address the resident’s actual situation:

• • “At risk for choking and aspiration related to swallowing difficulty (or related diagnosis).”
  • “Requires altered diet texture following choking incident during meals.”
  • “Becomes anxious during meals after recent choking episode.”

 

Goals may be short and/or long-term and should focus on both safety and quality of life:

• • “Will eat meals safely without further choking episodes.”
  • “Will maintain weight within 5% of baseline and hydration on the recommended diet.”
  • “Will feel comfortable and confident eating in the dining room again as evidenced by…”

 

Interventions should clearly tell staff what to do and how to care for the resident during meals – and identify who is responsible. For example:

• • Provide mechanical soft diet with nectar-thick liquids as ordered. (Dietary, CNAs, Nursing)
  • Seat resident fully upright during meals and for 30 minutes afterward. (CNAs, Nursing)
  • Speech therapy to follow for swallowing exercises and recommendations. (SLP)
  • Monitor for coughing, wet voice, pocketing food, or shortness of breath. (CNAs, Nursing)

 

The plan should also be reviewed regularly and revised when needed to protect the resident’s safety, dignity, and enjoyment of daily life.

 

 

Next Steps:

1. Join Proactive on June 23, 2026 for Clarifying CAAs and Care Planning presented by Eleisha Wilkes, RN, GERO-BC, RAC-CT, RAC-CTA, DNS-CT, QCP as part of the TEAM MDS! monthly series.
2. Plan ahead to attend the full day workshop Welcome to the World of Dietary on June 25, 2026
3. Take advantage of the June virtual MDS Orientation coming up on June 9-11, 2026
4. Subscribe to the Proactive Solutions Center for access to member-only resources, training and support to reduce the risk of adverse events.

 

 

 

 

Written By:

Candace Lord, RAI Specialist & Eleisha Wilkes, Clinical Consultant

Proactive LTC Consulting

 

Was this article helpful? Access weekly insights when you sign up for our weekly newsletter!