Elder Law

Elder Care: Nutrition and Feeding at Nursing Homes

In addition to receiving nutritious meals at nursing facilities, residents may be surprised to find that some of their favorite foods are served. Nursing facilities try to accommodate residents' food preferences and give feeding assistance to those residents who suffer from nutrition, dietary or eating difficulties.

Serving Regular Nutritious Meals

Residential care, assisted living or nursing facilities must serve residents a minimum of three meals each day at regular mealtimes and snacks before bedtime. When preparing and serving meals to residents, nursing facilities must try to provide:

  • Attractive and delicious meals, including ethnic foods
  • Alternative food choices that are consistent with the usual and ordinary food items provided by the facility
  • Meals at the times preferred by residents so long as the times requested are reasonable
  • Meals in a quiet enjoyable social setting rather than noisy dining areas or residents eating alone in their room

Sometimes, there are indications that a resident is having difficulty in the use of normal eating methods or techniques. Facility staff must be trained to observe when residents are not eating enough foods and must work with residents to maintain their ability to eat. The specific steps that a facility can take include:

  • Prompting the resident to eat
  • Providing residents with specialized utensils or other helpful devices and training with their use
  • Providing therapy to improve swallowing skills
  • Hand feeding the resident

Monitoring Nutrition Status

Nursing facilities must regularly monitor the residents' nutrition status such as body weight and protein levels. Losses in body weight of 5% over one month, 7.5% over two months and 10% over three months are causes for concern. Other conditions indicating that a resident's nutritional status may be a problem include:

  • A refusal to eat and a refusal of other methods of nourishment
  • An advanced disease
  • Increased nutritional or caloric needs that are associated with pressure sores or the healing of wounds
  • Radiation or chemotherapy treatments
  • Kidney disease, alcohol or drug abuse, chronic blood loss or hyperthyroidism
  • Gastrointestinal surgery
  • Prolonged nausea, vomiting or diarrhea that is not relieved by medication or treatment

If nutritional problems occur, the resident must receive a therapeutic diet that is ordered by a physician as part of a treatment for a disease or clinical condition that either:

  • Eliminates or decreases certain substances in the diet such as sodium
  • Increases certain substances in the diet such as potassium, or
  • Provides for food that the resident is able to eat such as easy to eat servings or a feeding tube

Tube or Intravenous Feeding

Facilities are not allowed to use feeding tubes unless the resident's condition has deteriorated to the extent that he or she is no longer able to eat enough foods alone or with assistance. Facilities using intravenous or tube feeding vary widely between states. The use of tube feeding may be unavoidable if the following indications are present:

  • The inability to swallow without choking or aspiration
  • The lack of sufficient alertness for oral nutrition or to eat alone or with assistance
  • Malnutrition that is not attributable to a single cause or causes that can be isolated or reversed

If the malnutrition indicator is observed, the facility must retain records to show that it has not been able to maintain or improve the resident's nutritional status through oral intake.

Questions for Your Attorney

  • How many meals does a nursing facility have to provide to a resident?
  • What can a nursing facility do if a resident is having trouble eating?
  • When can a nursing facility use a feeding tube to feed a resident?
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