Do nursing homes make sure the residents eat and drink?

The people at my mom's NH mostly worked on the "three tries" principle: ask three times and then count it as a refusal, which is within the rights of all residents - of course there were some employees who were better at getting compliance than others, I can remember lots of therapeutic fibs. People were weighed regularly and a noticeable loss was flagged, that meant a consult with the dietitian and care team to assess the reasons and strategize solutions, these could include adding supplements. assessing for dysphagia, supervised eating and/or being fed if needed. Of course with covid many facilities have closed congregate dining so that has made direct supervision much more difficult, it is much easier to supervise a table of 4 in the dining room than to try to check in on the same 4 people if they are each (or not eating) eating in their own rooms.

Schedule a care conference and kindly let the staff know your concerns. When my mother was in a NH we had these meetings regularly and they were a great help at having everyone informed and on board with the correct care

Pressure down and HR up is often heart failure. In the elderly it can lead to total systems failure especially with Covid-19 pneumonia. As you have already observed, even at home your MIL was not doing well. Force feeding any elder is exceptionally dangerous, leading to aspiration and aspiration pneumonia. You have mentioned dementia and no appetite, and I wonder what other underlying conditions may be at play here for a total failure to thrive that lead to MIL entering care now when Covid-19 is afoot in the land. As you may know, the caregivers in facilities often work not one, but two jobs and are constantly coming and going.
Please have the POA for MIL discuss with her doctors now whether it is time for palliative care, comfort care, and possibly hospice. You have not given your MILs age.
Certainly you can explore other facilities that might be willing to accept your MIL but I would wait until Covid-19 vaccinations have happened in your area for ease of visiting to assessing. Good luck.

Most nursing homes are always understaffed and COVID makes it even harder with constantly changing personnel. My first thought is to have her assessed for hospice services. Sounds like some of her recent problems could be considered a decline.

I’m sorry to hear but sadly you can’t get them to drink because of a suggestion. The thirst drive in the elderly diminishes with age. Add dementia on top of that and it’s hard to keep them hydrated. Pretty much a losing battle and the staff are overwhelmed so don’t count on that much. My dad would never drink even though fresh water daily by his bed or chair was in his care plan. Finally they found he loved drinking Boost so he would have several of those a day. Also he loved having a coke. I had to supply them because the LTC stopped giving residents sodas. I agree that a care conference is needed and maybe some of these suggestions would help her with calories and hydration.

Unfortunately, the short answer to your question is 'yes, I believe an overwhelming majority of facilities are like this'. We are on our third facility with mom, and I'm praying that it's better than the first two. They all promise the moon, and then do almost nothing to keep those promises. Sure, we can make excuses that they are understaffed because of covid or whatever, but, honestly, I think that most places are like this. They are a business, after all. Their main goal is to make money. Off of our love and concern for our parents or other relatives. If there is any way to get her into hospice, I strongly recommend it. That seems to be the one bright spot in our country's elder care system. So much attention , care, and knowledge was available to me through hospice when my dad was starting to fail. If that isn't an option, keep,looking for other facilities that could help your MIL. Having had bad experiences at other facilities helps you ask better and more precise questions when looking at new facilites. My heart goes out to you. It's exhausting.

Nursing homes are perpetualy short staffed.
They should monitor what they bring in for her to eat and what's left
Make sure you are raising your concerns to the administrator , daily if you have to
Our elderly parents need us to be their advocates.

I placed my 68 year old husband in one of the top memory care facilities nearby, paying out of our retirement fund monthly, since September, 2020. He now has lost over 20 pounds and I've questioned the nursing staff several times about this concern. I was informed that he was eating and drinking good, and the weight loss is probably due to eating more healthier food and no junk food that he occasionally had at home. I'm mainly concerned about him being dehydrated, because he always drank coffee, water, and a soda every day. I understand this is part of Alzheimers, not knowing when or if they are hungry or thirsty. I've been taking him a couple sodas a week, along with an apple, and snacks. He drinks the soda, but when I peek in his window while visiting (no indoor visits, thanks to Covid), I notice that his snacks are still laying around on his desk or night stand. Not sure if he even remembers what they are or how to open them. I frequently ask him when he calls if he's eaten, and if someone is there at his same table to eat with him. It is my understanding that it's the staff's responsibility to have a worker sit with the residents during meals. But when I asked the staff if they monitor what and how much he eats, they said "no". This really concerns me. I am comfortable, though, that our primary doctor visits with the facility and stays in touch with the facility nurse about any changes, i.e., medicines, vitamines, etc. It's all just overwhelming of the various changes one goes through with this horrible disease, which never gets better. My husband always says he feels good, but does he actually know when he feels bad? He can't identify objects, and his concentration when conversing has diminished. Facilities are short staffed, but I think they should at least make sure that they meet our requirements for caring for our loved ones. Especially for the price we are paying. When it gets to the point when the resident no longer can do for themselves, the only thing they can recognize is care, love, and TLC. I pray that the employees keep this in mind. Meantime, all we can do is Pray.

If you have a hall full of patients to feed, and one person can take over an hour--do you honestly believe they are going to be able to so? They will simply chart "refused" That is why I never put my mom in a SNF and are cesspools of disease even before COVID. I mean if one patient had scabies, the rest of them would. If one patient had the flu, it rapidly spread to the rest. C-diff diarrhea is also common in nursing homes since doctors feed them antibiotics like a salad, even for a cold. Compounding the problem is that nursing homes are short staffed, and there is a high turnover. CNAs are poorly paid and it is very difficult, back-breaking work. It is safer to work for Wal-Mart.

Staff can also be assaulted by patients, and not all CNAs report this to the charge nurse. When the patients assault staff they need to be put in a psychiatric facility and medicated to control behavior. Patients hitting, kicking, spitting at staff is yet another source of stress for CNAs.

But taking care of someone with Alzheimer's at home will completely consume your life and you will not be able to work; it is very hard and very very stressful, and EXTREMELY expensive. Many people do not have a choice but to put them in a SNF. I took care of my mom at home for 15 years, and it nearly destroyed me emotionally when she died. She made it to age 90, which was nothing short of a miracle considering she had insulin-dependent diabetes (I had to give her injections three times a day, but I kept her sugar levels absolutely stellar), high cholesterol which I could NOT treat due to her liver disease, and years and years and years of kidney disease as a complication of diabetes. Mom's medical management was highly complex, and in the end I had to put a feeding tube in her so she would not die of dehydration--she did great with it and I though she would last another ten years! Ironically she died NOT from Alzheimer's but kidney and liver failure which means even if she were a self-caring walkie-talkie the same would have happened to her...and her skin did not have one single mark. That feeding tube alone was a LOT of work because you have to check residuals, keep it patient, and assess the tube site and keep it clean. Mom never bothered it. It was a last resort, and she was pretty much no longer responding to the environment. I bought "tube tops" from Amazon to keep the covered which was comfortable for mom. But mom consumed my life and the moment I woke up to the point I went to bed it was around-the-clock care. So when mom died it nearly destroyed me emotionally but I had to recover, which I did, and I'm gainfully employed and working toward my Master's degree.

Just call me a recovered caregiver. I miss my mom. God I miss her..but people do die and it's a part of life. Mom is forever free from Alzheimer's and her litany of chronic illnesses. The feeding tube made mum comfortable in the end as her needs were met but her other diseases of kidney and liver is what got her. Mom was on hospice for 2 years and she was only bed ridden for 2-1/2 months because I worked hard to keep her going and walking. Even then I used a hoyer lift to put her in her favorite chair in the living room a few times a day. I thought it cruel to keep in her in bedroom all day. Besides I Had to change her diapers very frequently and keep her clean. Oh and her bowel schedule. Thank God for lactulose and her feeding tube. She moved her bowels every Tuesdays, Thursdays and Sundays like clockwork. To prevent impaction.

Did you know NOT ONCE did hospice ever have to use the "emergency pack". Not once did I have to give her any narcotics or psychotropics. Hospice nurse came daily when mum was dying (when symptoms appeared of liver failure she died within days), and they were surprised how comfortable she was with no drugs, and her death was the most peaceful one could ever hope for.

You calling people who put their parents in a nursing home a disgrace is very hurtful and unproductive.

Who are you to judge people like that?
Not everyone is afforded the luxury of the resources to be able to bring their parents home and quit their jobs to care for them.
I thought this forum was to help others, not to judge and make people feel horrible about their decisions.
Please try to help instead of judging. There is only one who can judge and even he doesn't.

When my dad was in rehab the day staffing was good and it seemed he was cared for. The evenings and nights I found out later were horrible due to short staffing. Dad was bedridden due to toe amputations. He lost 20 lbs and begged me not to send him back there. I arrived everyday to feed him lunch and paid a private sitter to feed him dinner. He was not cleaned in a timely manner at all. It was a very hard situation but the hospital sent him there. Staff was expected to feed many patients at the same time.

Get the hospital social worker involved and either move her to another facility or get more help at home.

My MIL is in LTC in a well-run facility. What I have learned is that by law (in my state) they cannot control what a resident eats or drinks, however, I'm not certain if this is conditional to them having signed a DNR when they moved in or not. When I requested that my MIL not have her dessert put on her tray until she ate some of her main meal (because she was only eating dessert and nothing else) they said they couldn't do that because that's considered "withholding food". No matter how I argued with them about it they would not do it.

But they do record what she eats and how much. At the quarterly meetings they could tell me her weight and any change, and how much food she was intaking. When my MIL had covid last May there was a span of time when she barely ate or drank. Because of her DNR they would not give her IV fluids. She thankfully recovered, but it has been very eye-opening to learn the many rules and regulations the hard way. If her facility is in the throes of a covid outbreak, I guarantee the admin and staff are running around like their hair is on fire Ithat's how it was my MIL's places). As the staff get covid they are understaffed and there are no subs available. You will have to be patient with this situation until they can get it under control.

Your situation is an example of why people need to fill out their Living Will with their physician's guidance: because a non-customized form may not do what you think it will. FYI most doctors think the standard advance care directives are NOT helpful in providing guidance and carrying out the wishes of the signer. I wish you much peace in your heart as you work through the care challenges. And do not pay any attention to trolls on this forum who try to shame you for your decisions.

As a CG for 10 plus years, I have had many seniors in assisted living and memory care at various facilities. Every single one promising the absolute best and most compassionate care in the industry. When families realize that their LO is declining, losing weight, or something just does not line up with the promises made at lease signing, I am asked to go “visit”. There are always a select few staff members that do have integrity and a heart caring for seniors. But they are far and few between and can’t be there 24\7. I have seen, year after year, countless residents at various stages of disease unable to physically or cognitively feed themselves. Some had ALS or PSP leaving no ability to hold a fork or swallow safely. In the first year, I really believed that the staff simply were not informed or on the same page with each residents needs. No, they knew. Then I thought, I could help feed a struggling resident bc the staff was so short handed. But for legal reasons, being private care that is not allowed. So I would pull a family member aside and quietly, ask them if their loved ones care included feeding assistance & let them know that it was not happening. These places all promise the world for your LOs and do not disclose the staff/resident ratio unless you ask. Even if you ask, most often it is nowhere close. A group home or skilled nursing are possibly the best options for meal assistance. Unless you have private care or visit often and come during meals unexpected, you will never know although you may suspect. Mind you, all that I’ve seen over the years at multiple facilities was all preCOVID. With no visits since the pandemic, I am terrified just thinking of the thought of not being able to check on our LOs. Especially since the staff ratio was always low before Covid.

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.

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.
💕

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.

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.

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.

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

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!

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.

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

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."

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.

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.

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.

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.

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 !

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!

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.