It is against
Federal Regulations to allow a Resident to Starve or suffer significant
unless proper nutrition is given and it is otherwise unpreventable
The CMS Guidelines define what is "significant"
and what is "severe" weight loss:
SignificantWeight Loss vs Severe Weight Loss
1 month a weight loss of 5% is Significant Loss ; Greater than 5%
is Severe weight Loss
3 months a weight loss of 7.5% is Significant Loss; Greater than
7.5% is Severe weight Loss
In 6 months a weight loss of 10% is Significant Loss; Greater than
10% is Severe weight Loss
Several Ftags (Federal Regulations) also address
§483.35 Dietary Services
The facility must provide each resident with a nourishing, palatable,
well-balanced diet that meets the daily nutritional and special
dietary needs of each resident.
the facility must ensure that a resident--
§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
Each resident receives and the facility provides:
(1) Food prepared by methods that conserve nutritive value, flavor,
(2) Food that is palatable, attractive, and at the proper temperature;
"Food-palatability" refers to the taste and/or flavor
of the food.
"Food attractiveness" refers to the appearance of the
food when served to residents.
§483.35(d)(3) Food prepared in a form designed to meet individual
§483.35(d)(4) Substitutes offered of similar nutritive value
to residents who refuse food served
§483.35(e) Therapeutic Diets
Therapeutic diets must be prescribed by the attending physician.
The intent of this regulation is to assure that the resident receives
and consumes foods in the appropriate form and/or the appropriate
nutritive content as prescribed by a physician and/or assessed by
the interdisciplinary team to support the treatment and plan of
"Therapeutic Diet" is defined as
a diet ordered by a physician as part of treatment for a disease
or clinical condition, or to eliminate or decrease specific nutrients
in the diet, (e.g., sodium) or to increase specific nutrients in
the diet (e.g., potassium), or to provide food the resident is able
to eat (e.g., a mechanically altered diet). If the resident has
inadequate nutrition or nutritional deficits that manifests into
and/or are a product of weight loss or other medical problems, determine
if there is a therapeutic diet that is medically prescribed.
Ftag 322 Tube Feeding: §483.25(g)(2)
A resident who is fed by a naso-gastric or gastrostomy tube receives
the appropriate treatment and services to prevent aspiration pneumonia,
diarrhea, vomiting, dehydration, metabolic abnormalities, and nasal-pharyngeal
ulcers and to restore, if possible, normal eating skills.
Clinical conditions demonstrating that nourishment via an naso-gastric
- Lack of sufficient alertness for oral nutrition (e.g., resident
- Malnutrition not attributable to a single cause or causes that
can be isolated
and reversed. There is documented evidence that the facility has
not been able
to maintain or improve the resident's nutritional status through
CMS guidelines define what is meant by "unavoidable"
"Avoidable/Unavoidable" failure to maintain
acceptable parameters of nutritional status:
"Avoidable" means that the resident did not maintain acceptable
parameters of nutritional status and that the facility did not do
one or more of the following: evaluate the resident's clinical condition
and nutritional risk factors; define and implement interventions
that are consistent with resident needs, resident goals and recognized
standards of practice; monitor and evaluate the impact of the interventions;
or revise the interventions as appropriate.
"Unavoidable" means that the resident did not maintain
acceptable parameters of nutritional status even though the facility
had evaluated the resident's clinical condition and nutritional
risk factors; defined and implemented interventions that are consistent
with resident needs, goals and recognized standards of practice;
monitored and evaluated the impact of the interventions; and revised
the approaches as appropriate.
Call us at
617-479-4300 if a loved one has been victimized by a lack
of proper nutrition resulting in severe weight loss or starvation.