Elder Abuse: How Should Nursing Homes Prevent Malnutrition and Dehydration?
What are the legal obligations of nursing homes when it comes to monitoring and addressing malnutrition and dehydration? How do prevention and intervention strategies factor into their duty of care? And what should both nursing home staff and families of residents be watching for to detect poor nutritional health and prevent elder abuse and neglect?
At first glance, preventing malnutrition and dehydration seems simple: make sure residents eat and drink enough to stay healthy. But the reality is far more complex. Most nursing home residents are admitted precisely because they need help with daily functions like eating and drinking. This means that nursing homes bear a heightened responsibility to assess needs, implement care plans, and respond promptly to changes in a resident’s nutritional status.
What Do Federal Regulations Require of Nursing Homes?
Federal regulations make clear that nursing homes have a duty to maintain residents’ nutritional and hydration status. Facilities are required to ensure that each resident maintains “acceptable parameters of nutritional status” including their usual or desirable body weight weight range. (Exceptions may be made for medical contraindications or resident preferences.)
The Centers for Medicare & Medicaid Services (CMS) says a facility may be cited for noncompliance if it fails to:
- Identify and address malnutrition and dehydration in high-risk residents.
- Ensure residents receive adequate hydration to maintain overall health.
- Develop and regularly update care plans based on accurate assessments of nutritional status, clinical standards and resident goals and preferences.
- Provide appropriate interventions to support healthy food and fluid intake.
- Offer therapeutic diets tailored to medical needs.
- Notify the attending physician when a resident’s nutritional status requires medical attention.
Failure to meet these standards can lead to citations, penalties, and even legal action for elder abuse. An elder abuse attorney can help you understand if your loved one’s circumstances meet the criteria for elder abuse and neglect.
Key Assessment and Intervention Strategies
To fulfill their obligations, nursing homes must conduct regular assessments and implement evidence-based interventions. These may include:
- Tracking Food and Fluid Intake: Staff must track daily consumption to identify the early warning signs of malnutrition or dehydration. Accurate documentation is crucial for effective response.
- Dietitian Assessments: Registered dietitians assess nutritional risk and develop personalized meal plans tailored to each resident’s health conditions and preferences, updating them as necessary.
- Swallowing Evaluations: Speech therapists perform assessments for residents with dysphagia, recommending texture-modified diets or thickened liquids to prevent choking and aspiration.
- Feeding Support: For residents with physical impairments, staff may need to assist with restorative feeding, use adaptive utensils, or ensure appropriate positioning during meals. Residents with memory loss or cognitive impairments may need prompting to eat and drink properly throughout the day.
A coordinated, interdisciplinary approach is essential. When a specialist identifies a risk factor affecting nutrition or hydration, that information must be communicated across the care team. Poor communication can result in delayed diagnoses and inadequate interventions.
Meeting Special Dietary Needs
Many residents require special diets due to chronic conditions like diabetes, renal disease, or high blood pressure. These diets must be carefully planned to ensure they meet the resident’s nutritional needs without exacerbating their underlying health conditions.
- Swallowing Issues: Individuals with dysphagia may need modified diets, including softened, chopped, or pureed foods and thickened liquids.
- Supplemental Nutrition: Residents with small appetites or high caloric needs may benefit from snacks between meals or nutritional supplements.
- Palatability Matters: Meals should be both nutritious and appealing. Residents are more likely to eat and stay hydrated when meals are visually appealing, flavorful, and tailored to their preferences.
Malnutrition and Dehydration in Elder Abuse Cases
Malnutrition and dehydration often develop gradually, making them difficult to detect until significant harm has occurred. For this reason, early identification and thorough documentation of symptoms are critical in potential elder abuse and neglect cases. If you suspect your family member has experienced dehydration or malnutrition in a nursing home, a dedicated elder abuse lawyer can help you determine whether you have grounds for an elder abuse lawsuit.
