I look forward to the evenings my wife and I go out to dinner. I confess that I enjoy food. But, it wasn’t until I represented my first nursing home patient that I began to appreciate the central role food and water play in skilled nursing case.
Good nutrition is vital for the well-being of nursing home patients. It provides the calories, protein, vitamins, and minerals necessary for improving and maintaining the quality of life. The elderly do not have the reserves nor the immunity that a young person has. So, it doesn’t take long for an elderly patient to lose ground without proper nutrition.
By the same token, inadequate nutrition cannot only diminish the quality of life, but may also begin a downward spiral resulting in death.
Understanding “nutrition” in the nursing home requires us to consider the physical act of eating, the quantity of food consumed, and the quality of the food consumed.
The Act of Eating
Eating three well-balanced meals a day can save your life if you’re a nursing home patient. You may be thinking, “doesn’t every nursing home patient get three meals a day”?
“Eating” is the operative word. When a nursing home is short staffed, which is not an uncommon event, patients who are unable to feed themselves suffer.
Feeding a stroke patient or a patient with dementia a meal takes time, as long as an hour in certain cases but mealtime is a scheduled event which begins and ends on a schedule. Attempting to rush a disabled patient with feeding can result in choking or the aspiration of food into the lungs, which can lead to pneumonia.
When a facility lacks adequate staffing, patients unable to feed themselves may go without eating meals. Food trays placed in front of disabled patients may be taken away untouched without regard to the patient’s nutritional needs.
The most productive thing the family of such a patient can do is to visit and observe during lunch and dinner.
Percentage of Meals Eaten
Nursing homes keep track of the percentage of meals eaten on a “flow sheet”. This information is documented by the nurse assistants. The quantity of food served is calculated to provide a certain amount of calories and protein at each meal. A patient who consistently fails to eat meals will neither receive sufficient calories nor protein.
Given the lax nature of documentation in nursing homes, any notation as to percentage of meals eaten must be suspect. The scale is a patient’s best friend.
Unplanned Weight Loss
Patients who are unable to feed themselves should be weighed once a week to determine whether there is loss of weight.
Any unplanned weight loss must be addressed by nursing administration, the dietitian, and the patient’s physician immediately.
Protein: The Building Block of Life
Consuming an adequate amount of protein is important for every nursing home patient. It becomes a matter of life or death for patients recovering from surgery or patients who have developed pressure ulcers (bed sores). Protein is used by the body to repair damaged tissue, so inadequate protein results in the body’s inability to heal wounds.
Every nursing home is required, by federal regulation, to have a dietitian. Families of new patients should meet the dietitian to discuss the patient’s nutritional needs. Families should also meet with the dietitian at any time the patient isn’t eating well or is losing weight.
We may live to eat, but in a nursing home you eat to live. Enjoy your next meal.
Our Next Article
Our next article will discuss the importance of strict nursing home regulation and enforcement.
The “Guardian Blog” will provide information to help both families and professionals assess and improve the quality of nursing home care in Arizona and the Guardian Blog will encourage dialog with and among its readers.
