Weight Loss Prevention
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BORUN CENTER STAFF TAKE A GOOD LOOK AT NUTRITIONAL CARE QUALITY
With this in mind we set out to first assess, and then improve, the quality of feeding assistance in nursing homes. Our approach has been somewhat unorthodox, and not only because it is based heavily on common sense. Throughout, we have employed quality control techniques that are more commonly used in factory assembly lines than in nursing homes. "Show me the food!" we demanded; the medical charts can wait.
Our researchers have spent hours in nursing home dining rooms, observing the staff, the residents, the meal trays, and recording what's done, what's said, what's eaten. When you station yourself in the dining room to directly observe mealtimes, you see things that would otherwise escape notice if your only information source was resident charts. Consider these findings:
- Nurse aides consistently overestimate by 15% or more the amount of foods and fluids consumed by residents, so many residents who are potentially at risk for weight loss, undernutrition, and dehydration are not identified (15). One study showed that the less a resident ate, the more likely staff were to overestimate the person's consumption.
- The majority of residents are at risk for undernutrition and dehydration due to low food and fluid intake (15, 16). These residents consistently eat less than 75% of their meals, one criterion used in federally mandated resident assessments, called Minimum Data Set or MDS assessments, to identify individuals at risk for weight loss and undernutrition.
- Most of the facilities we worked in did not have enough workers to adequately assist residents at mealtimes (14); this finding is in accord with a recent report to Congress, which noted that nine out of 10 nursing homes had too few workers to take proper care of residents.
- Due to understaffing, nurse aides "triage" residents at mealtimes, with the most functionally and cognitively impaired individuals, those who wouldn't eat a bite if someone didn't put it in their mouth, getting the most help (14, 17).
- The others are physically capable of eating on their own, with little or no assistance from staff, which is, in fact, all the help they get (14, 17).
- Of this latter group, many are at high risk for undernutrition, dehydration, and weight loss because they do not eat enough on their own (14).
- These at-risk residents don't consume many calories between meals either, though the staff will often swear they do. Staff are usually surprised when we report our findings, based on our own direct observations, that the average resident consumes fewer than 100 calories from snacks and oral nutritional supplements between meals. We've found that nursing home staff do not consistently offer residents foods and fluids between meals, nor do they provide appropriate assistance to encourage consumption--even when the resident has a physician order to receive snacks or supplements (18, 19).
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