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The Ombudsman Report for July 2023

Nutrition in Long-Term Care - More Than Just About the Food

by Kathleen Heren, Rhode Island's Long Term Care Ombudsman

Ombudsman's Report
Kathleen Heren

One of the most basic and life-sustaining activities in long-term care is nutrition. Why, then, is it the most ignored? Eating is not only life-sustaining, but it is also a time for residents to socialize with other residents. Families count on long-term care facilities to provide nutrition to their loved ones. When Covid-19 struck, families of residents with dementia, for example, were not allowed to enter nursing facilities to feed them.

As residents refused to eat, weight loss was immediate, and it was not long before facilities adjusted isolation procedures to be able to feed their residents. If you visit any facility at lunch or dinner, you will not see many families assisting with feeding. This is because staff are responsible for ensuring residents eat. However, nurses are not seen monitoring dining rooms during mealtimes, and residents could eat frozen seaweed for all the charge nurse knows.

It is also critical that staff who are feeding know the signs of choking and how to perform the Heimlich Maneuver. Although not required by regulation, a suction machine should also be nearby. For example, a suction machine would free the airway if a resident choked on a peanut butter sandwich, while the Heimlich Maneuver may not work.

Ombudsman's Report
Nutrition is a basic and life-sustaining activity in long-term care

Let’s speak about the mechanics of eating for the resident. I firmly believe a resident should not be fed by staff to make it faster. Providing finger food for residents who have difficulty handling silverware is great. I don’t even have a problem with someone using their hands if they eat the entire meal. I am certain you are cringing over what I just said. Consider how a baby learns to eat; why is it different for an Elder?

There are also specialized silverware and plates, making eating more possible. A Dietician can order these utensils after evaluating the resident. If a resident has some difficulty with motor skills, they may only need to be set up. What I mean by that is opening a milk carton, placing a straw in a drink, or cutting meat up.

Nothing is more maddening than finding a tray in a room where a resident did not have the head of the bed raised or propped up with pillows to make the meal easier to eat. If a resident needs to be fed, make it a pleasant experience by sitting beside the resident with the bed rail down. It may seem like I don’t understand how busy a nurse assistant is, but I do. Sometimes if there are two feeders in the dining room, an aide or nurse can feed two residents at a time and reduce the time a resident needs to wait to eat.

I chose this subject because I read many deficiency reports that are given concerning nutrition or weight loss. Supplements are fine and sometimes necessary, but these are not a replacement for food. When a resident is admitted into a skilled nursing facility, a dietitian should interview the resident or family about food dislikes. If a resident hates baloney, it should not be in a sandwich for that resident. Furthermore, dentures are wonderful - but not in a cup! A resident will eat better and have less chance of choking if their teeth are in.

Lastly, cover the residents’ clothing to avoid food stains that will ruin their clothes. I could go on and on, but if I have reached anyone about the importance of nutrition for the elderly, I have done my job. Remember, the importance of nutrition provision to residents is a vital part of long-term care.


Kathleen Heren

Rhode Island State Long Term Care Ombudsman

Office of the RI State Long Term Care Ombudsman Program

Alliance for Better Long Term Care Inc

422 Post Road Suite 204

Warwick, RI 02888



Ms. Heren provides a monthly guest blog to Connelly Law Offices, Ltd., where she discusses issues and topics that cross her desk as the Rhode Island State Long Term Care Ombudsman. The opinions expressed in our guest blogs are only those of the author(s). They do not purport to reflect the opinions or views of Attorney RJ Connelly III or Connelly Law Offices, Ltd employees.

Ombudsman's Report

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