Dehydration and Malnutrition Prevention and Intervention: Nursing Home Obligations
In last week’s blog, we looked at some of the most common risk factors for dehydration and malnutrition in nursing homes and other care facilities. But what legal obligations do facilities have toward their residents in terms of assessing malnutrition and dehydration? How do intervention and prevention strategies fit in to their overall duty of care? And what are some of the common signs of nutritional ill-health that facilities and families should look out for?
Preventing dehydration and malnutrition seems intuitively straightforward: simply ensure residents consume enough food and fluids to maintain good health. In practice, this objective is complicated by the reality of day-to-day care requirements. After all, nursing home residents are admitted precisely on the basis that they need help with basic daily functions.
Federal Requirements for Nutrition and Hydration
Federal regulations outline clear responsibilities for nursing homes regarding residents’ fluid and nutritional health. Facilities are required to ensure that each resident “maintains acceptable parameters of nutritional status, such as usual body weight or desirable body weight range and electrolyte balance, unless the resident’s clinical condition demonstrates that this is not possible or resident preferences indicate otherwise.”
According to the Centers for Medicare & Medicaid Services (CMS), a facility can be cited for noncompliance if it fails to do any of the following:
- Conduct accurate and ongoing assessments of each resident’s nutritional status during admission and as needed thereafter.
- Identify high-risk residents and address factors contributing to poor nutrition.
- Develop, implement, monitor, and adjust care interventions based on assessments, resident preferences, goals, and current clinical standards.
- Notify a physician when needed to help manage causes of poor nutritional status.
- Use appropriate strategies to help residents maintain healthy fluid and nutritional intake.
- Provide therapeutic diets where appropriate.
- Provide adequate fluids to support hydration and general health.
Facilities that fail to comply with these regulations may face legal consequences – an elder abuse attorney can help you identify when abuse and neglect has occurred.
Key Interventions and Assessments
There are a number of ways in which nursing homes can assess residents and pursue appropriate interventions to address malnutrition and dehydration. Typical assessments and interventions include:
Dietitian Evaluations. Registered dietitians play a critical role in assessing and addressing nutritional risks. Their role includes tailoring dietary plans to meet individual health conditions, preferences, and needs, adjusting them as conditions change.
Swallowing Evaluations. Speech therapists often conduct assessments for residents with dysphagia or other swallowing difficulties. These evaluations help determine appropriate food textures and fluid consistencies to ensure safe and adequate intake.
Monitoring Intake. Daily monitoring of food and fluid intake is essential to detect early signs of dehydration or malnutrition. Accurate documentation and regular review are vital for timely intervention.
Cueing and Prompting. For residents with cognitive impairments, caregivers may need to prompt or remind them to eat and drink.
Restorative Feeding Assistance. Residents with physical impairments may require support with eating or drinking. This can include adaptive utensils, special seating arrangements, or direct feeding assistance.
It should be noted that a collaborative, interdisciplinary approach is essential to effective assessment and intervention. For example, if a therapist identifies a condition that might be contributing to poor fluid intake, this information must be shared across departments. Failure to communicate may result in missed diagnoses and inadequate care.
Identifying Special Dietary Needs
Many residents have medical conditions – such as diabetes, kidney disease, or hypertension – that require special diets. Such diets must be planned and monitored carefully to ensure they meet the resident’s needs without worsening their condition.
Those with swallowing difficulties may require texture-modified diets involving the softening, chopping, or pureeing of solid foods and/or altering the viscosity of liquids. Others may simply need additional protein or calories in the form of nutritional supplements. For residents with a low tolerance for large meals (or just a generally small appetite), between-meal snacks can help maintain energy levels and provide necessary nutrients.
Whatever form they take, special dietary provisions should be both nutritious and enjoyable. Residents are more likely to consume meals and stay hydrated when food and drink is palatable and well-presented.
Malnutrition and Dehydration in Elder Abuse Litigation
Malnutrition and dehydration often develop subtly and slowly, and therefore may not be noticed until they cause serious harm. Identifying and documenting the symptoms and signs can be vital to establishing neglect in elder abuse cases. In next week’s blog, we’ll look at some of the warning signs, and how to spot them.
If you believe your loved one has suffered dehydration or malnutrition in a nursing home or other long term care facility, a dedicated elder abuse attorney can help you determine whether elder neglect and abuse has occurred. For a free consultation with an elder abuse attorney in Los Angeles, San Francisco/Bay Area, or Sacramento, contact Dudensing Law here.