Many nursing home residents are almost entirely dependent on the nursing home facility and staff to meet their Activities of Daily Living (ADLs). This includes relying on the facility for proper nutrition and hydration.
When families make the difficult decision to place a loved one in a nursing home, they have the right to expect that the facility and its staff will care for their loved one and provide a safe and nurturing environment. This includes, of course, providing adequate nutrition and hydration. Unfortunately, malnutrition and dehydration are common, albeit more subtle forms of nursing home neglect.
If you believe a nursing home is not providing your loved one with adequate nutrition and hydration or is abusing or neglecting them in some other way, contact the nursing home neglect lawyers at Robenalt Law today. We can evaluate your loved one’s medical records and care plan, answer your questions, and help resolve the situation.
The Importance of Proper Nutrition and Hydration for Elderly People
The importance of proper nutrition and hydration cannot be overstated, especially in high-risk populations like elderly nursing home residents. When elderly nursing home residents do not receive adequate food and water, they are at increased risk of pressure ulcers, falls and fractures, and death. In a nursing home setting, providing residents with proper and adequate water and food is often a question of having an adequate number of properly trained and supervised staff.
Federal Regulations Mandate that Nursing Homes Provide Residents with Proper Nutrition and Hydration
Because proper nutrition and hydration are so critically important for elderly nursing home residents, federal regulations require that nursing homes take specific steps to ensure residents receive proper nutrition and hydration. According to federal law:
- Long-term care facilities must provide the necessary care and services for the resident to attain the highest practicable physical, mental, and psychosocial well-being, consistent with the resident's comprehensive assessment and plan of care. 42 C.F.R. §483.24
- The facility must provide the necessary care and services to ensure that a resident's abilities in activities of daily living do not diminish unless circumstances of the individual's clinical condition demonstrate that such diminution was unavoidable. 42 C.F.R. §483.24 (a)
- The facility must ensure that a resident who is unable to carry out activities of daily living receives the necessary services to maintain good nutrition. 42 C.F.R. §483.24 (a)(2)
- The facility must ensure that the 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. 42 C.F.R. §483.25 (g)(1)
- The facility must ensure that the resident is offered sufficient fluid intake to maintain proper hydration and health. 42 C.F.R. §483.25 (g)(2)
- The facility must ensure that the resident is offered a therapeutic diet when there is a nutritional problem and the health care provider orders a therapeutic diet. 42 C.F.R. §483.25 (g)(3)
- The facility must ensure that a resident who has been able to eat enough alone or with assistance is not fed by enteral methods unless the resident’s clinical condition demonstrates that enteral feeding was clinically indicated and consented to by the resident. 42 C.F.R. §483.25 (g)(4)
- The facility must ensure that a resident who is fed by enteral means receives the appropriate treatment and services to restore, if possible, oral eating skills and to prevent complications of enteral feeding including but not limited to aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, and nasal-pharyngeal ulcers. 42 C.F.R. §483.25 (g)(5)
- The facility must provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs, taking into consideration the preferences of each resident. 42 C.F.R. §483.60
- The facility must employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, taking into consideration resident assessments, individual plans of care and the number, acuity and diagnoses of the facility’s resident population. 42 C.F.R. §483.60(a)
- The facility must ensure menus meet the nutritional needs of residents in accordance with established national guidelines; be prepared in advance; be followed; reflect, based on a facility’s reasonable efforts, the religious, cultural, and ethnic needs of the resident population, as well as input received from residents and resident group; be updated periodically; and be reviewed by the facility’s dietitian or other clinically qualified nutrition professional for nutritional adequacy. 42 C.F.R. §483.60(c)
- The facility must ensure that each resident receives and the facility provides: food prepared by methods that conserve nutritive value, flavor, and appearance; 42 C.F.R. §483.60 (d)(1)
- The facility must ensure that food and drink that is palatable, attractive, and at a safe and appetizing temperature; that food is prepared in a form designed to meet individual needs and accommodates resident allergies, intolerances, and preferences; that food options of similar nutritive value to residents who choose not to eat food that is initially served or who request a different meal choice; and that residents are provided drinks, including water and other liquids consistent with resident needs and preferences and sufficient to maintain hydration. 42 C.F.R. §483.60 (d)
- Each resident must receive and the facility must provide at least three meals daily, at regular times comparable to normal mealtimes in the community or in accordance with resident needs, preferences, requests, and plan of care. 42 C.F.R. §483.60 (f)(1)
- The facility must ensure that there are no more than 14 hours between a substantial evening meal and breakfast the following day, except when a nourishing snack is served at bedtime, up to 16 hours may elapse between a substantial evening meal and breakfast the following day if a resident group agrees to this meal span. 42 C.F.R. §483.60 (f)(2)
- The facility must ensure that suitable, nourishing alternative meals and snacks are provided to residents who want to eat at non-traditional times or outside of scheduled meal service times, consistent with the resident plan of care. 42 C.F.R. §483.60 (f)(3)
- The facility must provide special eating equipment and utensils for residents who need them and appropriate assistance to ensure that the resident can use the assistive devices when consuming meals and snacks. 42 C.F.R. §483.60 (g)
Nursing Home Neglect Causes Malnutrition and Dehydration
Despite clear laws requiring that nursing homes provide residents with food and water, nursing homes too often fail to provide for these most basic needs. The problem is typically caused by a lack of properly trained and supervised staff.
Residents who cannot physically move food and water to their mouths need assistance eating and drinking. If nursing home staff are unavailable to provide this basic service because they are too busy performing other tasks, residents do not receive the nutrition and hydration they need.
What Are Signs and Symptoms of Malnutrition and Dehydration?
Families of nursing home residents should closely monitor their loved one’s weight and hydration levels to ensure their loved one is receiving adequate food and water. The resident’s family should visit regularly and observe their loved one’s habits during meals, be aware of how the resident’s clothing fits, and ask about their appetite. The family should also be alert for other indicators of malnutrition, like dry mouth, decreased energy levels, skin changes, or complaints about not feeling well.
The family should also be alert for signs of dehydration, which include:
- Dry mouth and tongue
- Sunken eyes
- Darken urine or decreased urine output
- Feeling dizzy or lightheaded
- Fatigue or lethargy
- Confusion
- Muscle cramps
- Nausea
If you suspect a loved one is suffering from malnutrition or dehydration in a nursing home, you must act quickly. In cases of a life-threatening emergency, call 9-1-1. If your loved one is not in immediate danger, you may need to gather evidence to confirm your suspicions. If possible, discuss the situation with your loved one. Ask them about their appetite and the food they receive, and make note of their response. Document any unexplained changes in weight or mood. You may consider speaking with nursing home management, reporting the neglect to the Ohio Department of Jobs and Family Services (ODJFS), or filing a complaint with the Attorney General. You should also discuss the matter with a nursing home neglect attorney at Robenalt Law.
Contact a Nursing Home Neglect Attorney at Robenalt Law Today
If you suspect a loved one is suffering from dehydration or malnutrition in a nursing home, contact a nursing home neglect attorney at Robenalt Law today.
Robenalt Law has offices in Cleveland and Columbus and handles nursing home neglect claims throughout Ohio and nationwide.
Call our Cleveland office at (216) 223-7535 or our Columbus office at (614)-695-3800 or contact us online to schedule a free, confidential, no-obligation appointment to discuss your situation and how we can help.