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Our bodies need a nutritious, balanced diet. This is especially true for seniors with physical ailments or serious health concerns. A balanced diet helps seniors stabilize their medications, maintain healthy body weight, and further decreases the risk of heart disease, diabetes, high blood pressure, and other ailments. 

However, it isn’t always easy for seniors to maintain a healthy diet, especially when they struggle with ADLs (Activities of Daily Living) like shopping for food and meal preparation. In such circumstances, it may be best for seniors to move into a senior living community where the facility assumes responsibility for the resident’s diet, nutrition, and food handling. 

Many long term care facilities offer catered food services with in-house kitchen staff, who prepare regular meals for residents. Facilities must comply with a stringent resident diet system set out by the CMS to provide this service. The Dieticians of Canada list several guidelines for nursing homes and SNFs to ensure that the food served to residents meets CMS standards. These include:

  • Respecting residents’ rights by giving them autonomy to choose the food they prefer  
  • Recognizing that the quality of nutrition, amount of hydration, and degree of gratification enhance the residents’ standard of life and care
  • Embracing holistic concepts by recognizing the impact food and drinks have on the residents’ psychological and social well-being 
  • Making allowances for the residents’ eating habits in the past and how these impact their food preferences and nutritional needs
  • Taking into consideration the residents’ physical or cognitive ailments and assessing whether or not they can eat without assistance

The Challenge of Meeting CMS Nutrition Regulations

Most states issue a standardized dietary manual to ensure facilities comply with CMS nutrition regulations. For example, in Maryland, the Diet Manual for Long Term Care Residents is used as a reference guide in long term care facilities, community health programs, and chronic rehabilitation facilities. It is also used for prescribing diets, creating therapeutic menus, developing recipes, and planning and creating dietary care plans.

However, despite these guidelines, meeting the nutritional needs of every resident in a facility is still not an easy feat. Facilities face many challenges when preparing dietary care plans. They must cater to every resident’s unique nutritional needs. That means factoring in religious requirements, cultural differences, physical needs, food allergies, and personal taste preferences. The organization and preparation needed for ordering, cooking, and serving such a wide variety of food is monumental. 

Seniors eating lunch in accordance with CMS nutrition regulations
Facilities have a dietary manual following CMS nutrition regulations.

An easier way for facilities to track their resident diet system is through an efficient long term care EHR with built-in tools to streamline the processes. By accurately documenting all resident dietary requirements and preferences in a long term care software system, facilities can provide patient-centered care that considers a resident’s needs and wants. In addition, as nursing home software data is stored in a centralized location, all relevant staff can access resident information, including food preferences and requirements, easily, further improving the quality of care and satisfaction of residents. 

Another challenge facilities face is negative sentiments toward the quality of food served in nursing homes. Low-quality food can be the result of several factors, including insufficient staff, inadequate food preparation training, or even a lack of concern for dietary standards. Some nursing homes have elevated their food standards by providing gourmet meals in restaurant-style dining settings. 

Other times, food standards may be low at a facility on account of a small or poorly-planned budget. Because fresh and nutritious food is such a big expense, many facilities look for cost-cutting ways to reduce their food costs. The challenge is in finding a balance between reducing costs and maintaining resident satisfaction. Dakota Dieticians list some practical tips nursing homes can employ to minimize food costs. They include:

  • Have realistic food budgets – Facilities need to calculate their monthly patient per day (PPD) food budget using the following equation: Actual PPD food cost = monthly food expense ÷ number of resident days in a month. Once a facility has calculated its monthly PPD food budget, it can budget accordingly. 
  • Use fewer convenience items – While convenience items may save time in food preparation, they tend to be more expensive in the long run. For example, products like pre-cooked meats, ready-to-eat desserts, and pre-made hot dishes will significantly increase food expenses. Facilities should, therefore, opt for balanced meals that are cooked on-site. 
  • Reduce food wastage – The overproduction of food often occurs due to insufficient staff training and a lack of standardized recipes for staff to follow. An efficient long term care EHR system informs kitchen staff as to the current occupancy levels when preparing meals, thus reducing the likelihood of waste. In addition, nursing home software systems often provide standardized food production sheets with the proper food measurements for each meal in order to reduce food overproduction.
  • Buy in-season food products – Fresh fruits and vegetables are an essential part of a balanced and nutritious diet. The more fruits and vegetables that seniors have in their diet, the less likely they will suffer from illnesses like heart disease, stroke, cancer, or low blood pressure. However, out-of-season fruits and vegetables tend to be both more expensive and of lower quality. That is why in-season produce should be preferred. Dieticians and administrators can refer to this Seasonal Produce Guide to track the fruits and vegetables that are in season throughout the year.
  • Revise food inventory – A common problem in facilities is the over-ordering of food items. Sometimes, a surplus of food items occurs because certain food products are ordered for particular residents. However, should the resident pass on or transfer to a different facility, the item needs to be canceled. Therefore, facilities need to conduct regular inventory checks to review and revise food orders according to their care plan software and occupancy levels.

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10 Facts About CMS Dietary Regulations

Seniors meeting CMS dietary regulations by growing food from the facility gardens
CMS dietary regulations were updated in 2016.

Following revisions to CMS dietary regulations in 2016, facilities have updated their resident diet system to comply with the new standards, as failure to comply will result in f-tags and decreased CMS star ratings. The CMS regulations surrounding a resident diet system pertain to safety, storage, and cultural or religious demands. Armstrong Nutrition Management lists the top ten facts about CMS dietary regulations, and they are:

  1. A facility’s dietary services need to consider residents’ food preferences.  
  2. Facilities need to employ sufficient food preparation and services staff with the appropriate skills and competencies to carry out relevant responsibilities, including resident assessments and care planning in a long term care EHR.
  3. Facilities are required to employ a dietitian, either on a full-time, part-time, or consultant basis. The dietitian must hold one of the following qualifications:
    • Registration with the Commission on Dietetic Registration
    • Full-license or certification by the state as a dietitian
    • Clinical qualification as a professional nutrition expert
  4. A dietician that is contracted must have:
    • Certification as a dietary manager (CDM)
    • Certification as a food protection professional (CFPP)
    • Certification as a food service manager
    • A degree in hospitality or food service management with further training in foodservice management and food safety
  5. During the care planning process, a member of the facility’s food and nutrition team needs to ensure CMS nutrition guidelines are met. They will utilize the care plan software to see the resident’s history, thus devising an effective care plan. 
  6. All food prepared and served must be safe for human consumption. It must also factor in the religious, cultural, ethnic, allergies, intolerances, and personal preference needs of residents.
  7. Facilities must serve three regular meals per day following resident needs, preferences, and care plans. There must also be no more than fourteen hours between the evening meal and breakfast on the following day. It is also advisable for facilities to provide a nourishing snack at bedtime every night. The easiest way for facilities to track nutritional documentation and mealtime services is through their long term care software.
  8. When residents cannot eat independently, provisions and relevant equipment must be provided according to the resident’s needs.
  9. In accordance with local laws and state regulations, facilities may procure food from the facility gardens, local producers, farmers, or local growers.
  10. Facilities must adhere to professional health and safety standards when storing, preparing, distributing, and serving food.

For further details on CMS nutrition guidelines, refer to Section §483.60 of the Food and Nutrition Services in the CMS State Operations Manual to Surveyors for Long Term Care Facilities. 

How an EHR Helps Manage a Resident Diet System

Seniors in a nursing home eating snacks as part of their resident diet system
Dietary managers need to plan a nutritious resident diet system.

There is no one-size-fits-all when it comes to meal planning and dietary requirements. Planning a resident diet system can be stressful and complicated, especially because of the multitude of CMS nutrition regulations to follow. The best way for dietary managers and dieticians to monitor the varying needs of residents is through long term care software systems with features like Point of Care charting, care plan systems, and quality assurance documentation

Advanced technology, coming in the form of nursing home software or long term care EHR, can provide staff with real-time alerts, warnings for weight loss or gain, and reminders on a resident’s meal card and care plan. Hence, facility staff can identify, organize, and track changes to residents’ food preferences and needs, improving the  dietary management process, workflow, and efficiency.  

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Cindy Wong
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