Malnutrition and Staffing Issues

Weight loss, malnutrition and dehydration together form one of the most troubling epidemics sweeping the country’s nursing homes. Many nursing homes do not provide residents with a wide selection of food choices at mealtime.  Rather, many meals are predetermined.  Further, due to the limited number of available staff in the nursing home, meals are often rushed, and residents do not intake enough food to stay healthy.

Nursing Home Reform Act of 1987

Federal law has been enacted that addresses the issues of malnutrition and dehydration in nursing homes and long-term care facilities. The law is codified as the Nursing Home Reform Act of 1987 (NHRA). As the law pertains to the issue of hydration, a nursing home facility must provide the residents with sufficient fluid consumption to maintain proper hydration and health.  Similarly, regarding nutrition, the law requires that each resident be provided with adequate nutrition to maintain acceptable body weight and protein levels unless the resident has a clinical condition that makes maintaining such levels impossible.

There are some diseases, whether pre-existing conditions or conditions that are newly developed after being admitted to the nursing home, that may interfere with the resident’s ability to be adequately nourished, despite being provided with plenty of food and water.  For example, cancer and kidney or liver damage can cause malnutrition, as well as the resident’s refusal to intake food or water provided to them. When a resident has a condition that interferes with the resident’s ability to be properly nourished or hydrated, the nursing home staff is required to administer the appropriate treatment and services for the condition.

Nursing homes must also provide residents with a therapeutic diet if there is a situation in which a resident requires the correction of a nutritional problem. For situations in which it has become impossible or challenging for a resident to feed him or herself, the nursing home staff is required to provide assistance to the resident.

Inadequate Staffing Can Spur Dehydration and Malnutrition

When staffing levels are not sufficiently adequate in the nursing home to provide proper care, dehydration and malnutrition cases are all too common.  When too few staffers are on hand, staff may sometimes cut corners or take shortcuts in their duties, such as rushing residents through meals, or merely placing meal trays in rooms, but not providing assistance to residents with the acts of eating and drinking. These shortcuts are more frequently taken with care provided to residents who have cognitive impairments (i.e., dementia or Alzheimer’s disease), as these residents are unlikely or unable to complain or notify anyone of the mistreatment.

Sometimes the inadequacy isn’t a matter of low numbers of staffers, but rather the quality of the care provided by the staff.  Lack of training or a deficiency in the number of available licensed professionals can be the source of staff inadequacy. For example, certified nursing assistants (CNAs) are required to be supervised by licensed professionals, such as licensed practical nurses (LPNs), licensed vocational nurses (LVNs), or registered nurses (RNs).  The poor management of staff and the rate of staff turnover are also identifiable inadequacies.

If you suspect that your loved one is victim of abuse of neglect at the hands of nursing home staff or home health care staff, those responsible should be held accountable. Please contact Robert Rooth today at (847) 869-9100.

Sources: Sarah G. Berger, et al., Malnutrition and Dehydration in Nursing Homes: Key issues in Prevention and Treatment, The Commonwealth Fund, June 2000.