Long-Term Care Concerns
Feeding Assistance Is on the Way!
By Becky Dorner, RD, LD
Vol. 6 No. 1 p. 48

We all know that acuity levels in nursing homes have risen in the past 10 years or so. We all know that many more residents need assistance to eat and drink: verbal cueing, physical cueing, and partial or total assistance with feeding. We all know that many facilities face staffing shortages that make it difficult to provide the trained certified nursing assistants who can provide the help needed for these debilitated residents. And unfortunately, the old law and regulation made it impossible for anyone other than a licensed professional, a state-tested nursing assistant, or a volunteer to assist residents with eating and drinking. (Volunteers were built into the old law and regulations so that family members could feed their loved ones).

Now There is Good News for Nursing Facilities
Help with feeding residents is on the way! On September 26, Health and Human Services Centers for Medicare & Medicaid Services announced the final rule for Medicare and Medicaid Programs; Requirements for Paid Feeding Assistants in Long Term Care Facilities. The rule permits long-term care facilities to use paid feeding assistants to supplement the services of certified nurse aides under certain conditions. The intent of this new rule is to provide more residents with assistance to eat and drink to reduce the incidence of unintentional weight loss and dehydration.

The rule was effective as of October 27; however, each state must approve training programs for feeding assistants using the federal requirements as the minimum standards. Feeding assistants must complete a state-approved training program. The federal rule lists the minimum course requirements as the following (but states may add items to these minimum requirements):
• feeding techniques;
• assistance with feeding and hydration;
• communication and interpersonal skills;
• appropriate responses to resident behavior;
• safety and emergency procedures (including the Heimlich maneuver);
• infection control;
• resident rights; and
• recognizing changes in residents that are inconsistent with their normal behavior and the importance of reporting those changes to the supervisory nurse.

Facilities must also maintain a record of all individuals who are used as paid feeding assistants who have successfully completed the state-approved training course.

Paid feeding assistants must work under the supervision of a registered nurse or licensed practical nurse. In an emergency, a feeding assistant must call a supervisory nurse for help on the resident call system. The hope is that proper training and supervision will minimize any potential risk to the residents and provide numerous benefits to residents’ health.

Paid feeding assistants can only feed those residents who have no complicated feeding problems such as difficulty swallowing, recurrent lung aspirations, and tube or parenteral/IV feedings. Resident selection must be based on the charge nurse’s assessment and the resident’s latest assessment and plan of care.

Now is the Time for Dietetics Professionals to be Involved
What a great opportunity for dietetics professionals to be involved in the development of their state guidelines for training. Contact your state health department to find out what is being done in your state. Will they be adapting the federal rule as written, or will they be adapting it to fit the needs in your state? Get involved and be a part of the decision-making process. Many states are already finalizing drafts, but many others have not even begun.

This is also a great opportunity to expand your services and offer to do the training in nursing facilities. By downloading the Federal Register, the information and background related to this new rule is readily available. The document is available from the Federal Register online database in pdf format at http://a257.g.akamaitech.net/7/257/2422/14mar20010800/edocket.access.gpo.gov/2003/pdf/03-24362.pdf.
Training resources can be purchased or developed to assist in taking on the challenge and opportunity of training feeding assistants.

Looking for Training Materials?
The Consultant Dietitians In Health Care Facilities (CD-HCF, a dietetic practice group of the American Dietetic Association) has released several new publications to assist facilities in training paid feeding assistants:
• Eating Matters: A Training Manual for Feeding Assistants — $17.95
• Eating Matters Feeding Assistants Manual — $7.95

Both available from CD-HCF/ADA by calling 800-877-1600, ext. 5000
• Assisted Dining: The Role and Skills of Feeding Assistants — $19.25

Available from the American Health Care Association by calling 800-321-0343 or through ahcabookstore@ahca.org

When it comes to volunteers, encourage some training for them as well. Because litigation is such an issue for facilities, it is the wise thing to do.

— Becky Dorner, RD, LD, is a speaker and author who provides publications, presentations, and consulting services to enhance the quality of care for our nation’s older adults. Visit www.BeckyDorner.com for free articles, newsletters, and information, or call 800-342-0285.

Reference
Rules and Regulations. Federal Register. 2003;68(187).

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