It is against Federal Regulations
to allow a Resident to Starve or suffer significant weight loss
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 this problem:
Ftag 360
§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.
Ftag 325
§483.25(i) Nutrition
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
problem
Ftag 364
§483.35(d) Food
Each resident receives and the facility provides:
(1) Food prepared by methods that conserve nutritive value, flavor,
and appearance;
(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.
Ftag 365
§483.35(d)(3) Food prepared in a form designed to meet individual
needs; and
Ftag 366
§483.35(d)(4) Substitutes offered of similar nutritive value
to residents who refuse food served
Ftag 367
§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
care.
"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.
Intent §483.25(g)
Clinical conditions demonstrating that nourishment via an naso-gastric
tube is
unavoidable include:
- Lack of sufficient alertness for oral nutrition (e.g., resident
comatose); and
- 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
oral intake.
CMS guidelines define what is meant by "unavoidable"
nutritional parameters::
"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.
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