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Nursing homes, elder facilities and other types of resident and
skilled care facilities must provide each resident with a nourishing,
palatable and well-balanced diet that meets daily nutritional and
special dietary needs. Dehydration or malnutrition can be a
particular problem with the memory-impaired, such as those
suffering from Alzheimer's disease or dementia.  

If there is a change in the health of the resident, the facility must
consider how that change might impact the resident's nutritional
status, and amend the care plan accordingly.

In California, nursing homes have a duty to provide an individual
plan of care for every resident, which includes a risk assessment
for dehydration and malnutrition.  The plan must provide for
sufficient nourishment to maintain good health, and must be
updated on a regular basis.  The failure maintain adequate
nutrition, it is well know, can lead to a variety of serious medical
conditions, including death, and can expose a nursing home to
legal liability.

Additionally, care facilities must:

•        Serve at least three meals daily, at regular times, within not
      more than a 14-hour span between the evening meal and

•        Offer snacks at bedtime

•        Reasonably accommodate resident food and mealtime

•        Offer a food substitute of similar nutritional value if a resident
       refuses food

•        Serve food attractively, at the proper temperature, and in a
      form to meet individual needs

•        Prepare and follow menus that meet national dietary

•        Plan menus with consideration of the residents' cultural
      backgrounds and food habits

•        Post the current and following week's menus for regular and
      special diets

•        Prepare food using methods that conserve nutritive value,
      flavor, and appearance

•        Provide therapeutic diets to residents with nutritional
      problems, subject to physician orders

•        Ensure that a resident's ability to eat does not diminish unless
       it is medically unavoidable

•        Provide individualized help to residents who need assistance
      with meals, offering enough assistance so that residents can
      finish meals

•        Provide special eating utensils to residents who need them

•        Provide table service to all residents who desire it, served at
      tables of appropriate height

•        Store, prepare, distribute, and serve food under sanitary

If a resident's ability to eat is compromised, the facility should
establish an individualized care plan to maintain the resident's
ability to eat food orally.  For example, therapeutic programs can be
used to help improve a resident's ability to swallow or to help a
confused resident maintain a fixed eating routine.

Nursing homes must notify a resident's physician immediately if
there are signs of malnutrition, such as a weight loss of 5 pounds or
more within a 30 day period.  Federal guidelines urge care facilities
to reassess nutritional status whenever a resident experiences
unplanned or undesired weight loss of 5 percent or more in one
month, 7.5 percent or more in three months, or 10 percent or more
in 6 months.


Care facility residents can become dehydrated when they are not
given sufficient fluids.  Symptoms of dehydration include dizziness,
confusion, constipation, fever, decreased urine output, and skin
problems.  Severe dehydration can lead to serious illness or even

It is the responsibility of care facilities to provide each resident with
sufficient fluids to maintain proper hydration and health.  Each
resident should be provided a plentiful supply of fresh water or
other beverages and be given any help or encouragement needed
to drink.

Dehydration and Malnutrition

Some studies suggest that one-third of the approximate two million
nursing home residents in the U.S. suffer from dehydration or
malnutrition, a problem that has been described by some
researchers as a silent epidemic.

Causes of dehydration or malnutrition in the nursing home setting
are many, but frequently include:

•        Fluid losses due to illness such as diarrhea, flu, or infections.
•        The side effects of certain medications.
•        The simple failure of the resident to be given adequate fluids
       or food.
•        An age-related decrease in thirst or hunger sensation.