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Nursing Home neglect
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Nursing Home Dehydration

It is against Federal Regulations to allow a Resident to suffer dehydration

Ftag 327 §483.25(j) Hydration
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 dehydration.
"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 diabetes);
- 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 drink;
- 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 include:
dry skin and mucous membranes,
cracked lips,
poor skin turgor,
thirst, fever),
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 and ensure
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 for
maintaining adequate fluid intake?
- If adequate fluid intake is difficult to maintain, have alternative treatment
approaches been developed, attempt to increase fluid intake by the use of
popsicles, gelatin, and other similar non-liquid foods?

Ftag 325 §483.25(i) Nutrition
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 problem.

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 indication.

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.

Call us at 617-479-4300 if a loved one has been severly injured by a lack of care resulting in dehydration.

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