Do nursing homes make sure the residents eat and drink?

Visiting someone in assisted living who often did not eat the employees said they only give them the food but they can't make them eat it. Sometime before I had been taking care of a neighbor with AZ who did not eat the meals prepared for him. Then I got the idea to get Chinese food from a restaurant that we both liked and I got a meal for myself too and we ate dinner together in his place. He ate it all and it seems that it was because we were both eating and talking as if we were normal people. So now I sat with this woman friend in AL during meals and she would usually eat some of the food. Of course not everyone can do that. It may be important for the social connection at meal time. I have also noticed that ice cream is usually accepted. I am told that a person can live on Boost or Ensure alone. I wonder if a plate of food is too complicated or too much work to eat. Then maybe one smaller dish of one item at a time. I also noticed with my neighbor that he often had a craving for snack items with sugar so I got him an assortment of those little cakes he liked. I also did this with my woman friend in AL. I would check and resupply those items. Also strawberry Ensure. Okay, it isn't a balanced diet but it is something and seems to make them happy. Also those little packages of peanut butter on crackers. And of course, cookies. Yes these might make them less likely to eat a real meal but if they don't want that anyway, what can you do?

Sounds like they are taking terrible care of her. I would call the ombudsman. (which will not be possible after you take her out.)
My wealthy aunt died in 3 months after being put in an expensive facility. I don't trust those places at all.

I’m happy to hear that she ate well. Hope that she continues to enjoy her meals.

I am sure that she will love your home cooked meals.

It’s so thoughtful of you to bring her favorite dishes that she loves.

Hi I’m back. She is in a skilled nursing facility. She has been released from the hospital and is back at the facility. The other family member who was the only one allowed to be at the hospital with her said that he would be talking with the facility about having someone to feed her. When he was there with her she was asking for something to eat. He got her something and she ate every bite. I do know that she is a picky eater. I don’t know if she is sleeping through mealtime, she doesn’t like the food, she’s forgetting to eat or is so unhappy she has no appetite, and her appetite showed up because she had a loved one there with her. I just don’t know. It’s hard to know what to do when you don’t know what is going on. We’re of course not allowed to come see her except through a glass door and it’s hard to hold a conversation that way. But, like I said, the other family member is supposed to have talked with them about feeding her. I’m going to take her something to eat when I can. She loves this one thing that I would cook for my household and would bring to her when she was at home and I’m going to take that to her every week. Anything else that I think she might eat I’ll also bring to her. Hopefully that will help. She’s picky but always has seemed to like my cooking for the most part. I’m sure other family will bring her food when they can. Or I hope they will.

Somebody tried to go see her the other day and she didn’t want to get out of bed to be wheeled out to the door, which is so unlike her.

My dad became dehydrated at the facility he was at last December. Despite my constant visits and speaking either the nurse He was declining steadily. The doctor would not recommend more IV fluids.
One night my daughter and visited and got him to drink water and ensure. All that time no one even tried, They were recommending hospice.
My gut said send him to the hospital Once there he fully recovered. I sent him to another facility. He was weak from that experience but did better for a few months until Covid hit.
Dehydration again despite my phone calls and reminders to be sure he drank. When we weren’t there I’m afraid they didn’t make sure he was drinking.
It can be their illness or dementia.
Also there’s no one really giving them one to one attention .

I think after a while my dad got so weak he couldn’t eat. He also had a terrible habit of staying up all night and sleeping all day therefore missing important meals. When he slept all day the staff couldn’t wake him. When I visited or my children
we had to leave he was in such a deep sleep.
As family you can visit and encourage them to eat but sometimes we can only do so much .

Best to you

NO. For whatever reason they won't devote the time to encourge people to eat.
My MIL was always a light eater. At 90 she would only take a few bites and say she was full even though she only weighed 115 Lb. SO when she was cared for
at home one lady would sit with her for an hour and over the course of an hour MIL would eat most everything on her plate. When MIL spent some weeks in the
nursing home, we paid this special person to go over at meal time to encourage MIL to eat her meals. Aggrivating but it did work. Otherwise the NH staff would remove her full plate within 15-20 minutes without a thought.

IMHO no they don't. They can not force someone to eat. The trays are often still full either due to the patio lack of being able to feed self, or just lack of wanting food in front of them.

Is she in assisted living, memory care, or skilled nursing? Each level requires different care with a greater staff to resident ratio. AL: residents need minimal care. Are independent. MC: residents may have Alzheimer’s and/or dementia. Increased level of care and supervision. SN: close monitoring of residents. May need complete assistance with activities of daily living, feeding, bathing, walking, etc. This is the highest level of nursing home care and includes making sure resident is adequately hydrated. Rehab is another level within a NH but is temporary until the resident no longer needs rehabilitative care, or has reached the highest level of recovery for their rehabilitative issue. Schedule a meeting with Director of Nursing, Unit Manager, Social Services., her Physician, and if possible one the nursing assistants consistently assigned to your MIL. Discuss your concerns, and the possibility that she needs a higher level of care. Ask that your MIL be given beverages she enjoys. As far as covid...not sure if MIL acquired it before moving to NH or from the NH. You will need to ask for their covid protocol. And you need to make sure your MIL and family members honor those guidelines. As far as falls: all levels of care try to prevent falls. However, unless your MIL is restrained to her bed or chair 24/7, (which is illegal), or has a 24/7 private assistant, it will be impossible to supervise her 24/7. If your MIL was living at home, falls may have happened that you were never made aware of. Communication is key. I would set up a meeting with director of nursing (or equivalent), floor supervisor, and if possible, the nursing assistant(s) who are most frequently assigned to your MIL.

Imho, the answer is no. When my mother was in a nursing home for a broken bone recovery, her sister found her dinner tray of food in the hallway. No one gave it to my mother. Sometimes nursing homes residents, on rare occasions, are seen wandering the hallways - at least it was so in the Nursing Home in my mother's town. Prayers sent.

Well first its possible she got the virus from when she was in the hospital but didn't show up until she got into the NH.  And you are right, they cannot be in each room all the time to make sure they eat and drink.  Now from my experience when my dad was in a NH, they do have drinks (water) in their room at all times.  And they have normal times to eat breakfast, dinner and supper.  IF they are eating in their rooms, normally when they take away the dinner tray they will let someone know how much (%) of their food they ate OR if they are eating at the dining area, there are people there to see how they are eating.  IF she has dementia just because they remind them to drink doesn't mean they will.  its up to them to drink. the only way that the resident will definitely get stuff into them is IF they cannot feed themselves, then they will actually feed them and make them drink.  I know I can remind my mother (who is at home and no dementia yet) to drink water at least 3 glasses a day and she won't do it because "it has no taste" or "I am not thirsty".  So you can't force them if they won't.  And you have to remember, in the NH they are dealing with routine checks of bathroom issues, bathing issues and they should all have set times.  and then you have some residents that ring their bell just because so when a aide has to be constantly trotting down the hall to care for one, another is having an issue.  And we all know that some NH do not have the fully staffed people they should, and if you have some out sick, that makes the others work double.  Talk to the administrator to see if there are any issues you have and see what can be done to help.  Again though, they cannot force someone to eat IF they don't want to.  And with the laws of not being allowed to have rails on beds due to being considered "restraints" they can only lower the bed as far as it will go and then put mats down on the floor on both sides of the bed.  wishing you luck but ask questions.

Nope, nope, she's responsible for drinking water, as long as she's upright with a pulse, then she's charted as being okay.

You mentioned Rehab ... Rehab is much different than long-term care, because it generates more cash revenue streams. and b/c rehab is the $$sales driver to get people into those Long-term Care rooms billed at $7,000 per month, Truthfully Rehab is the easiest selling-point into long term care, it's also the point where many fight to get advertised services at a typical outside pace. When they realize that Rehab exists for not much more than adult day care, they'll pull their family member back into life, by bringing that family member home. Before it's too late.

Perhaps Long-term care is better described as living in a Motel6, with 3 meals per day delivered to your mom by the local GrubHub and, daily med disbursements by the local drug dealer (nurse), with help from the front desk with showering and getting dressed. And maybe a 10 minute visit from someone, from physical therapy, who might take the person for a short walk, maybe.

BUT placing her inside a LTC facility ensures she will be found, eventually, by someone, if something goes wrong.
It's the same in every Long-term facility: she will get 3 meals per day, which she may or may not eat, because legally it's her choice to ingest food or drink.
Remember ALL facilities are the same, doing minimums, to make more money, All facilities underpay whilst over-working staff. I must add that "CarePlans," are just pieces of paper, to ensure someone has seen your family member at least 4 times per year.

At our facility, one resident describes LongTerm Care as the place where society stores old + disabled people, because they're inconveniences to society, He calls it a people storagefacility, with decent food, where nobody really cares what happens, who lives or dies, as long as that revenue stream keeps flowing .... you get the idea ...

If that is lower than your expectations then you'll need to understand that everything looks better on paper, but your mother is safer than she would've been living alone.

The short answer sadly is no. Nursing homes are understaffed and dinner time is a busy time. I was disheartened to see what happened to my dad. He had a change in medication to control seizures which left him with uncontrollable shaking of his hand and arm making the task of bringing a spoonful of food to his mouth impossible. He would sit in the dining room at his assigned table without any help. When I became aware of this, I insisted that one, they work with him to mitigate the problem, and two, help him eat. Their lack of assistance for him was cruel as he was hungry. I tried to be there for meals as often as possible and I hired a caregiver (that he knew) to sit with him during dinnertime. And like your experience, he had received very good treatment in the rehab side of the facility in the past. I feel for those family members who have loved ones in facility during Covid as that advocacy has been made much more difficult if not impossible.

Supposed to do and do are two different things. While working in a nursing home/rehab I saw trays placed before a resident who was asleep in a geri (geriatric) chair. When the tray was removed the tech charted "refused" to eat. BULL! I saw this time and again. Most resident lost significant weight. Other times when a resident was out of the room the room was either cleaned or sheets changed, etc., and the tray table (on which the carafe of water and cups were sitting) placed at the foot of the bed. The table was not moved to the bedside when the resident returned to bed. Many could never reach their water. Many, many days the water was not replenished before first shift ended or after the second shift came on. Who wants warm water, if there was any at all? Place a hidden camera or nanny cam in the room and DO NOT tell anyone it is there. It is not illegal, but unfortunately, recording sound is illegal. Check your state laws. The best thing is to be there every time you can. Check up on your loved one and let the facility know you are watchful.

In my opinion, even very good nursing homes are struggling to maintain proper staffing during this time of CoVId.

I believe they are mandated to record how much your mom eats and drinks. I agree with the suggestion that you ask for a family meeting on her care plan.

Once the vaccine has been widely distributed, I hope visitation will resume in care facilities. The families did so much more than just sit and chat. The loss of the family help with patient care plus the care restrictions caused by staff contracting or being exposed to CoVid are definitely affecting the care available to our elderly.

When my mom was in rehab, I went daily. I was surprised by how few people ate in the dining area. Most ate in their rooms, including my mom.

If they did not eat, they were always welcome to order a sandwich later if they were hungry, along with snacks like cookies. As far as extra drinks, all I ever saw was punch. They had a few vending machines too.

My mom loves ice cream. She doesn’t have diabetes. She’s very thin so she is one who can indulge. I brought the individual cups of ice cream for her.

When I got them out of the freezer for mom, the other residents begged for one so I went to the store and bought tons for everyone and asked the nurses who couldn’t have them for health reasons.

Oh my gosh, I became very popular with the residents after that!

I always dropped by around mealtimes and shared a meal with my mother and fed her at the same time to make sure she was cleaning her plate which she always enjoyed doing particularly because I was there. Unfortunately because the percentage of beds filled in the ASLs are down-- fewer CNAs are being hired so the CNA will usually be feeding more than one person at a time. Make sure you go by at mealtimes !

Unfortunately, you can't count on anyone else to really take care of your loved one, the way that you expect. Facilities are mostly understaffed and don't have resources to be there checking on residents at all times. It's a very unfortunate situation. I'm a strong believer in keeping family close, and paying for outside professionals to assist with care.

This is a difficult year for everybody with a COVID pandemic. Yes, the staff do offer food and drink to their clients. The clients have the right to refuse to eat or to drink and those rights must be respected. The staff will clean the clients that can not toilet or clean themselves.

May I suggest another view of your loved one's problems. She will not eat or drink enough - as she was doing before she arrived - and most likely continues to do now. If she was incontinent of bowel and bladder before she entered LTC, she is still going to be incontinent. Fecal incontinence can lead to more UTIs. Less fluid intake leads to UTIs, lower blood pressure, higher heart rates, and increased risk for falls. Unless a person is tied down (which is a huge no-no everywhere) you can not prevent falls from happening. If your loved one has osteoporosis, her bones will have thinned enough to fracture when she stands - and then she falls.
Every residential facility takes measure to prevent injuries to those prone to falling; ask to see their protocols. Ask to see their protocols for those who need snacks and extra fluids because of poor nutritional intake. Ask about how often she is bathed. If the information you read is satisfactory, it may be that your loved one would experience UTIs and/or falls/fractures in LTC or at home with family.
COVID exposure may or may not have anything to do with the LTC facility. If your loved one fell and was taken to the hospital for evaluation of a her fracture and treatment, she could have been exposed to COVID while there. A staff member or a new client could have COVID without symptoms and the rest of the clients would have gotten an exposure. CDC protocols are to reduce risk of exposure, but nothing can make that risk 0% - especially when you have many people together under one roof. Add to the fact that she is living with other people is her age, which puts her at risk of more serious disease. Unless you are willing to take your loved one home and never leave the house, you and she will most likely have several potential COVID exposures every week.
One of the problems with COVID is that it causes pneumonia. Unfortunately, this is how this disease works. Some people get mild symptoms and others can develop pneumonia, heart/vascular problems, digestive problems, neurological problems... It is hard to see your loved one get sick with this disease.
I don't believe that the LTC facility is not taking care of your loved one. I believe that she is facing the same problem LTC facilities all over the world are facing - keeping their residents healthy during a pandemic that seems to target them for worse disease. When the vaccine is available for her and yourselves, please get vaccinated.

From my experience with my father it was hit or miss on helping him eat in the skilled nursing section of the nursing home.Some of the staff would help and others did not. When I visited him in his room in skilled nursing there would be a full tray of food untouched because nobody helped him. They did not help him in the dining room. My mother may be going to skilled nursing next and I might hire someone to check on her eating habits if they allow it. This is a top rated place also. I suggest being cautious and dont assume they will help with eating.

Unless someone is getting spoon fed, per dr orders, it's highly unlikely anyone is watching or accurately recording what someone ate/drank each day. They drop a tray and come back and get it. Period.

Talk to her doctor first, at hosp, to find out if her problems may require better care at the facility. Or perhaps more care/different care than she's getting. Then ask him to put those orders on her record upon release from hosp. It's very likely there's another doctor (or his PA) assigned to nursing home. Perhaps he can also send written record to that doctor. Then follow up with nursing home to find out what they will be doing to accommodate.

If you can't go inside the facility because of covid to observe on your own, you may need to call more often to ask questions specific to her care and document each conversation even if you have to record it. Anytime you have concerns, call and ask. If you can't get inside, it will take more daily conversations with her to know what is going on if she can communicate things to you. You might also check it out to see if you can hire a private health care provider to do in and be your eyes for you.

Covid is being brought in to the facility by employees more than likely. New patients should be quarantined upon arrival, so that would indicate spread is from employee/new patient or employee exposure when they are not at work.

My mother-in-law was in Memory Care, and my husband went there every day after work, and would give her an energy drink like Boost or Ensure, and she drank it with gusto. She also had dehydration issues. When asked, sometimes the aides would say, "She wasn't hungry or thirsty at dinner;" I don't think they encouraged her much in that regard. I hope your MIL gets better soon. My mother also had Alzheimer's, but she lived with us. I even wrote a book about our experiences taking care of her called, "My Mother Has Alzheimer's and My Dog Has Tapeworms: A Caregiver's Tale."

EDIT: Sorry, Dr. Carlone I meant your MIL.

Its a good idea to meet with the Memory Care Coordinator and express your concerns and go over her care plan. Make sure any needed doctor's orders are in her file as well. Its okay to emphatically, but politely, state your care requests and expectations. Might she drink more from a fancy water bottle or cup? Bring one in, with her name on it, with instructions on how often to encourage fluids, or how often to refill. And when you are able to visit, make sure your requests are being followed. And be sure to thank the staff when things are going well. Yes, its their job, but positive reinforcement works.

Get her out of there as soon as you can! In home care is best where she or you can direct her care and hire the people you want. There are programs that help with the funding of this in every state.

They DO NOT help them eat or drink ...just the opposite. They KILLED my sister by not giving her any food or water for 4 days. She died of dehydration! They said she was actively dying (she was NOT dying ...had a seizure and recovered). The fact is they decided it was time for her to die and withheld all food and water. I was going to sue, but found out this is NOT uncommon and is a form of euthanasia. I am looking into starting a petition to STOP this! DO NOT LET THEM DO THIS TO YOUR MOTHER. By the time I found out what they were doing it was too late. This is a horrible way to die. Very painful and should be illegal. I thought it was, but it happens a lot. PROTECT YOUR MOM!

This saddens me. There may be 2 parts to the situation. Staffing and her disease. AZ affects many parts of the brain in the process of nutrition. There needs to be signals that go from hunger, to knowing how to use a utensil, to getting it to the mouth, to chewing and swallowing. If any pathway is gone, the person loses the ability to adequately stay well.

The other issue I have personally seen when visiting NH or ALF as a Hospice nurse or Home Health nurse is an aide bringing in a meal tray, putting it down in front of someone no longer mentally or physically able to self-eat. I've then seen them return some time later, comment "guess you weren't hungry" and take the tray away. Once while I sat with my terminally ill patient, I assisted the roommate.

Even in my years working in a hospital patients would leave with significant weight loss often for the same reasons. Request STRONGLY a dietician be consulted who should get blood work ordered some of which can indicate starvation.

In this time of Covid, it is so difficult not to be able to be present to feed one's loved one. Best of luck

My mother-in-law had dementia. She would forget to drink - and didn't seem to care about eating unless I (or her daughter) was sitting there with her encouraging her. Often I would have meals with her. She ate better when I was there - so I would try to come for lunch four or five times a week.
When the lockdown came her daughter sent the nursing home a letter telling them that we feared she would starve to death. I offered to go in every day and have lunch with her and spend a couple hours with her caring for her and doing her physical therapy and exercising - which I had been doing for 15 months - EVERY WEEK. I have been her doctor for 30 years -- since 1989. In 2005 I married her daughter - and became her son-in-law, but to her I was still her "Dr. John" and she always called me that.
I admitted her to the nursing home in 2018. Because of her dementia she required 24 hour care and supervision. With their knowledge and implied consent I not only treated her in the facility - but other residents and employees. When the lockdown came I advised them that I would be the one to continue her care -- going in every day for 4-6 hours to be sure she ate, got her vitamin supplements and did her walking and stretching exercises. The new nursing home administrator - who had just arrived in March 2020 and did not know my history at the facility - and refused to allow me to continue to care for her. She slowly starved for two weeks. She never asked to meet with me to allow me to explain what care I was providing and why it was medically necessary.
We were called the morning of 3/27 to come immediately - as she lay thin-emaciated-dehydrated and gasping for every breath.Her daughter held her hand as she died. Her body was almost totally mottled. The nurse tried to tell her daughter that it has happened "fast". That extent of mottling would have taken SEVERAL hours and I told them that what they were claiming was wrong. It meant that she had most probably laid in bed, gasping for breath for hours as her body shut down. There was no way to bring her back. They had let her deterioration go too far.
They broke the CMS regulations and violated her civil rights by denying her the care of her personal physician who would have saved her life.
Her daughter - with the help of the best attorneys for Nursing Home Litigation in New York State -- BrownChiari will be suing the facility at some point.
It is my hope that they also sue the NYSDOH who labeled me as "non-essential" -in an apparent effort to justify the mistake of the new administrator and her team.
I believe she would still be alive today had I been allowed to continue to care for her and monitor her health. I have testified to same.
Our elderly are being seriously neglected during this isolation. It is my opinion that the Isolation is responsible for more deaths than the Covid virus. They are giving up, they feel abandoned and they slowly weaken to a point of no return.
I will continue to advocate for them and ask that the facilities be open to family immediately. This would not only give the residents hope - and better care - It would improve the quality of care and the staffing which has dropped to a new low during this pandemic.
Maxine was happy and loved her family, her friends and bingo. She should still be here walking, smiling and singing.

In my state, long-term care facilities are regulated by the State. You might want to check the facility's ratings and whether there have been any complaints or lawsuits. Talk to her doctor and case manager at the facility and tell them your concerns. Can you specifically ask the case manager to make sure that she is adequately hydrated. Some facilities also have community groups and ombudsmen to help. Also ask how she fell. Is she trying to get out of bed by herself and is too weak? My mother needs a hospital bed with the bars to prevent her from trying to get out of bed. She needs to be assisted with everything. Moves are very difficult for people with dementia. Try to make things better where she is before you move her.

I have been in the senior health and housing environment for over 10 years and I can say truthfully, all facilities, AL and LTC were shorthanded prior to covid-19, possibly due to the ridiculously low salaries. The situation now is only worse, with staff members taking off because they are ill. And even with the lockdown to visitors, staff members can't stay there 24/7 - they have to go to their homes and deal with their families.
And and since many facilities had to eliminate the congregation of Residence Inn their dining room where it was much easier for a few CNAs to walk around and remind people to eat oh, now that the residents for the most part have to eat in their own rooms the ability to pop in it out even within an hour is really limited -trust me there are not that many CNAs available to do anything -changing, diapering, toileting coaching for eating - during the midst of covid. And it's even worse at night.
Falls are always impossible for anyone to prevent and of course with less staff to watch over residents who try to get up also going to be for more frequent.
Sorry you are going through this and wish I could offer an answer.
I I would however definitely ask for a care conference and I would ask it to be with the unit manager as well as the dln and the social worker. I would explain my concerns diplomatically of course and see if they can come up with a long and short-term solution.
I am a great believer in contingency plans so develop one which means also check for other facilities - some do manage this situation slightly better than others.

Good on this difficult journey and please keep us updated.

I’m so sorry you’re going through this. As a PT that works in a facility, I have to say that Covid has changed so much in our healthcare facilities.
When our residents are admitted they are quarantined in their room for 14 days. This can be devastating to their mental health as they are in a new environment, are often confused, and have limited interaction with other people.
Im not sure about your specific facility, but in ours all residents are encouraged to remain in their rooms more than pre covid. This is to help limit the chance of covid passing from one resident to another as quickly if it’s introduced into the facility. Having more residents in one area made it easier for staff to assess if they were drinking, eating well, and offered social interaction which often helps them to acclimate to the new facility and schedule.
I agree with having a care plan meeting with the facility, tell them the specific things you’re concerned about and offer strategies that you had seen work at home. You could also ask if they could do physical therapy, occupational therapy, and speech evaluations. Speech will look at cognition (which stage of dementia) and how well she is eating, drinking related to cognition, as well as any mechanical issues of swallowing. OT can look at any mobility issues related to her eating, drinking, toileting, and PT can look at her general mobility. All of these disciplines will offer strategies to the nursing staff to help care for your MIL. Knowing cognitive status is really important because as dementia progresses there’s a corresponding decline in desire and ability to eat, drink, move, etc. Knowing the stage that your MIL is in may help you to determine potential next steps.
💕

In my state, my understanding is that they are obligated to offer a certain amount of food and drink. They cannot force a resident to eat. However, they obviously should be aware enough of the resident's nutritional intake so they can notify the family or medical director that the resident isn't taking in very much.