Nutritional Status in Long Term Care

April 11, 2023

Maintaining Nutritional Status in Long-Term Communities

CMS Guidelines in Long Term Care communities regarding Maintaining Acceptable Parameters of Nutritional Status, such as usual body weight or desirable body range and electrolyte balance are recommended to be met by “Improving intake with wholesome foods preferably to adding supplements.  Examples of interventions to improve food intake include:

Balancing Nutrition1) Fortification of foods (adding protein, fat, and carbohydrate to foods)

2) Offering smaller, more frequent meals

3) Providing between-meal snacks or nourishments

4) Increasing the portion sizes of the resident’s favorite foods

5) And when needed providing a nutritional supplement during medication administration and not at meals unless preferred by the resident

For residents needing additional nutrition, Crandall Corporate Dietitian’s menu program has over 40 fortified food recipes available to serve in place of the regular item specified on the menu program.  There is a REGULAR version, a No ADDED SUGAR version, and a LACTOSE RESTRICTED version.

It is very important for the Registered Dietitian (RD) on their visits and as they are writing up their QA Audits to watch a cook prepare a fortified food using the fortified food recipe. This is very important because recently a RD was auditing a breakfast meal and when the RD saw the fortified hot cereal, she asked to see the recipe and the Cook stated, “Oh I just sprinkle extra sugar over the top of the hot cereal.”  This is very concerning because the fortified cereal recipe furnishes 427 calories and 8.84 grams of protein whereas the unfortified cereal recipe offers 75 calories and 2.8 grams of protein.  When a Registered dietitian is calculating the nutritional needs of a resident and sees that a fortified food program has been ordered it is imperative that the RD can be assured that the resident is receiving the calculated calories and protein that the diet order should be offering.

Therefore, the CLEAR message is that recipes must be followed on ALL Menu Items, Fortified as well as Texture Modified, Therapeutic and Regular recipes!!!  If a CMS surveyor identifies that recipes are not being followed and there is a negative outcome for a resident, the Scope and Severity could be Level 4 Noncompliance: Immediate Jeopardy!!!

To request more information or a demo of our Crandall Menu program, visit our site here.

Categories: Meal Service, Nutritional Assessment, Quality of Care