Nutrition and Hydration

For nutritional and social reasons, mealtime makes one of the most important activities of the day for people in long-term care. As per state and federal law, nursing homes need to accommodate for nutrition and hydration needs by providing good-tasting, nutritious, and well-balanced meals and make sure residents receive proper hydration throughout the day.

Requirements for Meals

According to the National Policy and Resource Center on Nutrition and Aging, 35-50 percent of older residents in nursing homes suffer from malnourishment. The Centers for Medicare and Medicaid Services (CMS) publish regulatory requirements for meals that long-term care facilities must follow.

To ensure adequate nutrition for the elderly, menus must be planned in advance and approved by a certified dietitian. If residents refuse the food served, substitute items of equal nutritional value must be offered. At a minimum, nursing homes must serve breakfast, lunch, dinner, and one bedtime snack with appropriate spacing between meals, and caregivers should accommodate patients who prefer to eat at other times. Food should be neither bland nor too spicy, properly cooked, inviting, and served at the appropriate temperature.

Special Diets

Special, therapeutic diets must be planned by the facility’s dietitian and approved by the physician. For residents who have problems with chewing and/or swallowing, food must be ground, pureed, or thickened. In order to encourage independence, special utensils and other equipment must be offered, and staff should be trained to provide appropriate assistance.

Feeding Assistants

Inadequate staffing makes one reason elderly nutritional needs suffer in nursing homes. Caregivers attend to many residents, which may affect the time they have to spend with each one. Because many residents need assistance with food and drink, the federal government now sets aside money for states to hire and train feeding assistants. These staff members work solely to help residents with their dining and hydration needs.

Proper Hydration

Dehydration makes another common problem for older people in long-term care. Many factors contribute to improper hydration for elderly people in nursing homes including a reduced sense of thirst, fear of incontinence, and gastrointestinal and swallowing issues. Educating residents on ways to maintain adequate hydration helps as well as follow-up from dietary and caregiving staff. Several other methods help ensure proper hydration for aging residents:

• Full pitchers of fresh water and cups kept at beside tables
• Service of foods high in water content like melon, popsicles, and gelatin
• Beverages served with straws and/or garnishes
• Physically handing drinks to residents
• Identification of patients at high risk for dehydration
• Labelling doors of high-risk residents with symbols for extra hydration care

Complaints

Residents in long-term care and their families have a right to voice concerns over dietary and hydration practices. Concerns should be shared with the dietary manager, director of nursing, or facility administrator. If concerns do not receive prompt attention, family members should call the nursing home hotline in their state for information about recourse.

Ensuring proper hydration and meeting elderly nutritional needs requires the cooperation of all nursing home staff members. In being consistent and proactive, nursing homes help ensure the health and well-being of residents and reduce worry and concern in family members.