Daniel Brooks is the assistant administrator at the skilled nursing facility where Margaret resides.

He is responsible for supporting Sofia with:

• managing daily operations

• regulatory compliance

• resident care

• staff management

Daniel strongly believes that federal law is clear regarding patient autonomy for healthcare decisions and when facility administration can revoke that autonomy.

Daniel spent several years in his early career working in a facility with a high level of patients with mental illness, who sometimes required a 5150 involuntary hospitalization. He was taught that facilities are only legally allowed to revoke patient autonomy in cases where the patient is at imminent risk of significant harm and that stripping them of their legal right to autonomy requires strict legal thresholds , processes, and documentation (Cleveland Clinic, 2025). He was taught that facilities are not legally supposed to remove someone’s autonomy just because their choice may be perceived as “unsafe” (Horner et al., 2016).

He is aware that the facility has previously experienced litigation unrelated to dysphagia care, which has increased administrative anxiety regarding adverse medical outcomes.

Daniel worries that restricting autonomy for residents with aspiration risk without proper procedures in place may:

• reduce the patient’s trust in the healthcare team

• cause the patient to experience unintended complications from refusing to eat or drink

• violate federal laws and create liability risk for the organization

• place the facility at risk for state-level compliance tags

Daniel states:

“If we remove a patient’s right to choose their healthcare interventions without appropriate legal processes in place, who are we really protecting?”

Daniel believes his policies are intended to protect vulnerable residents and maintain safe standards of care.