Food and Nutrition Issues In Nursing Homes  
Meals help meet many needs for all persons, in and out of nursing homes. In nursing homes, meals and mealtimes are especially important. Many nursing home residents have special nutritional needs. Others may need food specially prepared due to digestive disorders. Mealtimes are one of the most important activities of each day and provide an important opportunity for social gathering and sharing. Due to their social and nutritional significance, meals are a major concern for most nursing home residents.

What are my rights concerning meals in my nursing home?

All nursing homes must meet the following dietary requirements:

  • Your meals must meet recommended dietary allowances for persons of your age and sex;
  • At least three meals shall be served daily, at a regular time, with not more than a 14-hour span between a substantial evening meal and breakfast;
  • Menus for the current week shall be posted in the dining room or other public place;
  • Hot foods shall be served hot and cold foods served cold;
  • Meals shall be served in an appetizing and sanitary manner;
  • Supplemental fluids and special nourishments should be provided if ordered by the physician;
  • The facility must provide each resident with sufficient fluid intake to maintain proper hydration and health;
  • Based upon a resident's comprehensive assessment, the facility must ensure that a resident (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 (2) receives a therapeutic diet where there is a nutritional problem;
  • Nutritious snacks must be offered several times daily;
  • Food should be served cut, ground, chopped, pureed, or in another manner which meets your needs;
  • Medicare and Medicaid certified nursing homes must consider your personal preferences. If you refuse food served, you should be offered a substitute with similar nutritional value.

Who is responsible for my meals?

Your physician is responsible for identifying special dietary needs you may have. The nursing home must have a dietary or food services supervisor in charge of meal preparation who meets state training requirements. If the food services supervisor is not a registered dietician, the supervisor must receive at least eight hours' supervision from a registered dietician.

Can I get a special diet if I need one?

Yes, nursing homes are required to provide special diets, as needed. Your physician will need to prescribe your special diet and give it to the food services supervisor. The food services supervisor may also be able to assist you with arranging a special diet.

What if I need help with feeding?

Nursing homes are required to assist you if you need help being fed. This assistance should be provided at the time meals are served so that hot food is still hot and cold food is still cold. The nursing home should ensure that you eat a sufficient amount of food to meet your nutritional needs. If you can feed yourself but need supervision, adequate supervision should be provided regardless of whether you eat in the dining room or your own room.

If I have problems with my meals, what should I do?

Food complaints are among the most common complaints in nursing homes. Good nutritional and fluid intake are very important to the elderly and those with illnesses. If you have concerns regarding the food, meal service or special dietary concerns, bring them to the attention of the Food Services Supervisor and, if necessary, the administrator of your home.

Many times, the Resident and/or Family Councils have taken food and nutrition issues to the home's administrative staff members. Their actions have been instrumental in the improvement of the quality of the food service.

What can you do if these discussions do not resolve your concerns?

The Long Term Care Ombudsman (LTCO) may be able to help you or you may wish to file a formal complaint with the Office of Regulatory Services. However, most food concerns are not easily resolved by contacting regulatory agencies. Another approach, which may be more effective, is to address these concerns through the home's residents' council or family council, if they exist. Working with other residents or family members may help you show that problems are not isolated and attract more attention to your suggestions. If you need to file a formal complaint, the fact that your concerns are shared by other persons may help gain needed enforcement action.

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