It is against Federal Regulations
to allow a Resident to suffer dehydration
Ftag 327 §483.25(j)
The facility must provide each resident with sufficient fluid intake
to maintain proper hydration and health.
The intent of this regulation is to assure that the resident receives
sufficient amount of fluids based on individual needs to prevent
"Sufficient fluid" means the amount of fluid needed to
prevent dehydration (output of fluids far exceeds fluid intake)
and maintain health.
The amount needed is specific for each resident, and fluctuates
as the resident's condition fluctuates (e.g., increase fluids if
resident has fever or diarrhea).
Risk factors for the resident becoming dehydrated are:
- Coma/decreased sensorium;
- Fluid loss and increased fluid needs (e.g., diarrhea, fever, uncontrolled
- Fluid restriction secondary to renal dialysis;
- Functional impairments that make it difficult to drink, reach
fluids, or communicate fluid needs (e.g., aphasia);
- Dementia in which resident forgets to drink or forgets how to
- Refusal of fluids; and
- Did the MDS trigger any CAAs (Care Area Assessments) for dehydration?
What action was taken based on this information?
A general guideline for determining baseline daily fluids
needs is to multiply the
resident's body weight in kg times 30cc (2.2 lbs = 1kg), except
for residents with renal or cardiac distress.
Each Nursing Home must Identify if a resident triggers any CAAs
for dehydration/fluid maintenance, and cognitive loss.
Clinical signs of insufficient fluid intake
dry skin and mucous membranes,
poor skin turgor,
abnormal laboratory values (e.g., elevated hemoglobin and hematocrit,
potassium, chloride, sodium, albumin,
transferrin, blood urea nitrogen (BUN), or urine specific gravity)?
Ongoing duties to hydrate require thenursing
home to determine:
- What care did the facility provide to reduce those risk factors
adequate fluid intake (e.g., keep fluids next to the resident at
all times and
assisting or cuing the resident to drink)? Is staff aware of need
maintaining adequate fluid intake?
- If adequate fluid intake is difficult to maintain, have alternative
approaches been developed, attempt to increase fluid intake by the
popsicles, gelatin, and other similar non-liquid foods?
Ftag 325 §483.25(i)
Based on a resident's comprehensive assessment, the facility must
ensure that a
§483.25(i)(1) Maintains acceptable parameters of nutritional
status, such as
body weight and protein levels, unless the resident's clinical condition
demonstrates that this is not possible; and
§483.25(i)(2) Receives a therapeutic diet when there is a nutritional
The intent of this requirement is that the resident
maintains, to the extent possible, acceptable parameters of nutritional
status and that the facility:
o Provides nutritional care and services to each resident, consistent
with the resident's comprehensive assessment;
o Recognizes, evaluates, and addresses the needs of every resident,
including but not limited to, the resident at risk or already experiencing
impaired nutrition; and
o Provides a therapeutic diet that takes into account the resident's
clinical condition, and preferences, when there is a nutritional
Ftag 322 Tube feedings
§483.25(g)(2) A resident who is fed by a naso-gastric or gastrostomy
tube receives the appropriate treatment and services to prevent
dehydration and metabolic abnormalities.
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if a loved one has been severly injured by a lack of care resulting