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I'm usually at the NH daily to help mom with a meal but sometimes (like today) I just pop in at the end of lunch and find that she hasn't eaten more than a few bites, if anything. If she was at home I would make sure she had something later but in the NH I'm not sure she does, especially since she needs to be fed and there is an afternoon shift change by snack time. I'm just wondering what the normal way to handle this is at other nursing homes?

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Hi MAC, mom's already on thickened fluids and pureed foods. I know that she is approaching the end of her life but she's not there yet and will still eat when she is awake. My worry is that missing meals and the drinks that go with them will lead to even greater frailty, the NH doesn't seem concerned or at least they aren't telling me if they are. Really I'm just wondering how other places handle this issue?
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I don't know about nursing homes, but, the staff awakens the sleeping residents in my LO's MC. The residents are taken to the dining room for meals and snacks. Some nap in their wheelchair or geri chair as they wait. When the food arrives, they are awakened to eat. For those that need it, they are hand fed. I would question why the staff wouldn't awaken your mother for her meals. Are you sure they aren't doing that and she refuses to eat? I'd check to confirm what is happening.
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That was the way they did it at my mom’s MC too. Mom would claim she hadn’t been fed, but I knew she had.
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I'm told she is a "good eater" by the aides, but I have visited often shortly after meals and found her asleep at the table with her full plate being scraped into the waste bucket. I know she is put into bed after lunch and gets up again between 3:00 and 4:00, and giving her a substantial snack shortly before her 5:00 dinner just means she doesn't want to eat then. Maybe I'm fussing over nothing, maybe she is fine with 2 meals a day.
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CW, with so little activity, your mom may be fine with only 2 meals per day. My best friend's mom, who still lives with her and is 90, only eats light breakfast, snack mid day or bigger lunch, and snack or bigger dinner if she only ate snack mid day.
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CW I hate to say it but I think it's a bit of an open secret how many NHs handle this, isn't it.

Does your mother like yoghurt? Can you keep something like that handy for top-ups, if she feels like an extra little something when you get there?
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Do u have care meetings? Mine were only 15min long and pretty much onesided, theirs. The nurses kept me pretty much informed and I asked questions. You may want to ask for a meeting with the Social Worker and the staff who work directly with Mom. Tell them you want more than 15min because you want to ask questions. Why is Mom on pureed food? Because she is having problems swallowing? This will get worse. Why is she sleeping so much? If this is all pretty new, her body maybe just shutting down. They will not suggest it...but see what the head nurse thinks about Hospice.
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I read a lot about the progression of dementia, so, I look for the time that my LO's appetite will decrease and she will start sleeping more and more. I've read that is the body's way of shutting down. Of course, food should be offered, but, not pushed on the person. While my LO is now in the Severe stage, she still seems to have a good appetite. She went through a phase where she lost a lot of weight and refused to eat, but, I suppose her meds for anxiety and depression work pretty well. She's always read for meals and snacks.

Maybe, you could ask if they will keep a log of meals that your mother declines.  I suppose there is a fine line between encouraging and pushing too much. 
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Thanks everyone :)
I know they keep count of what they eat and drink, but I don't hear about it unless I ask and at this point I'm as tired of always asking about something as they probably are. Mom's definitely slowing down, but I last winter thought she wouldn't see another spring and here we are almost a year later.
One day at a time.
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I would also try to keep track of her weight. As my mom aged, she just didn't have much of an appetite. She lost weight but was pretty steady (I weighed her each week when I bathed her). If you know her weight, you can get a better idea of if she's eating enough or not.
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Sometimes inactive older people lose weight due to loss of muscle mass. My mother's weight had been going down although I'm told she eats reasonably well earlier in the day. I'm typically there for dinner (supper) and she usually eats little if anything. When she was younger and living at home, she usually didn't eat until almost 7 PM, and I think a some of the problem is that the evening meal is simply served too early for her. They also give her a pill along with Ensure or a similar drink, and she mentioned this spoils any appetite she would otherwise have. Some of the foods they serve are things she never ate at home or even in a restaurant (such as tacos, burritos, barbecued ribs, fried breaded shrimp, some "Chinese" items, etc.) and it's on her chart that she dislikes spicy foods, but sometimes that's the meal du jour. Often I'll end up eating or taking home some or all of her food if she insists she doesn't want any; this is okay with the staff but in another nursing home they wanted to know if she wasn't the one who ate her food (because they kept track) while this one doesn't seem to care much either way. However, if someone comes in and says "oh, you did a good job on this mean" I will say that I'm the one who ate it. Sometimes she'll eat a snack later or some fruit my sister or I bring. Her not being from this region may play a part in it, too.
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The only answer I can give is from some friends - they make sure they are there at mealtime and sit with their LO. Also, one brings nutritional shakes so it's a meal in a shake. If interested, I add Barlean's Chocolate Silk Greens to my DH's shakes to ensure he gets "the greens" - it seems to help a lot.

DH passes on solid foods as often as not and prefers his Hot Chocolate (ensure plus cocoa & Barlean's) with Ice Cream. We've been doing this all year and he's actually getting more cognitive and even willing to exercise now.

Still has Sundowners - but that seems to depend on how tired he is and if he can see me in the room. He might not know me before his nap, but he knows me upon waking. I learned to just go with it.
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If Mom is from another country her understanding of the language may be another problem especially if the Aides are also immigrants and have poor command Of English. Many older immigrants never did learn the language and their own language was spoken in the home. The kids of course went to school and did all the translating for their parents.
That haveing been said the problem here seems to be that Mom is allowed to sleep through meals. That is definitely a neglectful act, so start there and work on the reasons she leaves her food later.
Many nursing homes have strict rules like having to get dressed every day and go to the dining room for meals
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cwille, Your question sounds much like my situation. I attend husband's NH almost daily to help him eat lunch. On several occasions while other residents have been nearly through with their meal, I found my husband sound asleep on a chair near the cafeteria. No one woke him to eat. I was shocked. The aides were busy clearing tables, serving dessert, or standing around talking to one another. When I voiced concern I was told husband did not want to eat! Really! I did not see any indication anyone tried or cared to wake him. Don't accept this! Most aides simply want to get through with their shift and go home. Talk to the administrator, the NH's head nurse and spouse's doctor. Most doctors will NOT stand for this. If there is a registered dietitian, discuss your concerns with them. My husband lost 63 pounds in 5 months! Yes, 63 pounds. I strongly voiced my concern and also had his PCP and cardiologist call the NH. Guess what? I haven't found him asleep during meal time since. I feed him lunch, take Boost and chocolate milkshakes for afternoon snacks. If he wants cookies, he gets cookies, cake, pudding, candy, whatever. And regardless of what the administrative staff says, the aides at my husband's NH, do NOT offer to feed these people. I have seen residents trying to eat broth with a fork, other's dump their food on the floor. One gentleman filled his slippers with soup from the bowl, others refuse to eat, some cannot eat while aides completely ignore them. And, please note how attitudes from the staff change when you are there. All of a sudden I have noticed the phony caring, the fussing and doting that other residents are not receiving. You are your mom's advocate. If you suspect anything wrong, you owe it to your mom to voice a concern. I pay a premium to a NH and I refused to let some lazy aide sit idlely by and do nothing. You may also consider hospice help. I've only had hospice for a few weeks. Didn't know about hospice until now. They are a blessing. A true watchdog blessing. It's a free service paid by Medicare. The briefs, wipes and necessities are provided, they take blood pressure and check their patient's over-all health several times a week. If you do not have this for your mom, please check it out. Wishing you prayers and good luck.
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Oh my Grammy, at least my mom is at the table, not forgotten in the hallway!!
I try to be there for one meal each day so I see what is going on in the dining room. Slumber seems to be the norm at lunch, I'm sure that over half the food is wasted as many residents eat very little, if anything at all - this is true for those who can eat on their own as well as the ones like mom who are being fed. I sympathize with the aides, if they won't wake up long enough to eat what more can they do? I've had trouble myself getting mom to wake up to eat, but I can usually get her to finish her soup and juice, she doesn't need the rest.
I guess my frustration is that the routines are maintained regardless of the fact they aren't working for many -the majority? - of residents, what good is putting a check mark on a form saying you have provided the required balanced meal of xyz calories if you know that it is not actually being eaten?
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In the skilled care facility my LO is in, the reason he may not eat a lot for lunch is not enough time in between breakfast and lunch. If he doesn’t finish breakfast until 9 (he is a slow eater) and they start serving lunch at 1130-1145, that’s not enough time in between meals. As long as he eats 2 good meals a day I’m satisfied. But I’m there for both lunch and dinner so I can assist on bad days and just be Company on good days.
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So is the problem that the aide feeding her is leaving/departing the bedside too soon? If so, then even though she MAY be at EOL the staff should be alerted so she gets an opportunity to receive nourishment. That's a God given right. Blessings to you at this difficult time, cwillie.
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C Willie; unless you are there for all 3 meals everyday you'll never know how much she's eating...BUT I do know own that elderly people do NOT NEED as much calories as you or I. Because they are not active and the food could just be piling up in their system ...also sometimes older people just don't have a big appetite ...try bringing her pudding, and jello ,and ensure, yogurt ,ice cream, whatever she'll eat bring it with when you come in & wake her up to eat if she swallowing ok it'll be good for both of you.
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If you're prepared to pick this battle with a facility or nursing home, the figure to concentrate on is the BMR - Base Metabolic Requirement. This is the estimate of how many kCalories a body will burn every day just ticking over - heart beating, organs functioning, temperature maintenance, that kind of thing. Any calories not supplied in the diet will therefore be drawn from stored body fat (of which most individuals in western societies have plenty, so not to panic).

So if your loved one is in long-term care, and you're talking about a forward-looking plan rather than getting him/her through a crisis, it's legitimate to ask what the BMR is reckoned to be. And if they're not taking BMR into account when planning menus and monitoring intake, why aren't they? - they should be.
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