Food and nutrition regulations in long-term care

The Centers for Medicare and Medicaid Services (CMS) has specific regulations and standards for long-term care facilities. The Food and Nutrition Services department is no different. Below, we summarize the current food and nutrition regulations in long-term care.

Provide nourishing and appealing meals that take into account the resident’s food preferences. Meals should meet each resident’s unique nutritional needs and be flavorful and served at an appropriate temperature. Menus and individual meals should take into account the resident population’s cultural and religious food preferences and be updated as the residents’ needs change.

A qualified dietitian must be employed on a full-time, part-time, or consultant basis. If a dietitian is not employed full-time, there must be a qualified food and nutrition professional to serve as the director of food and nutrition services. This individual could be a certified dietary manager, certified food service manager, have completed a certification or higher education in hospitality or food service, or have previously served as a director of food and nutrition services in another long-term care facility.

The food and nutrition services department should be appropriately staffed. Staffing challenges always exist, but a long-term care facility should take action before staffing shortages impact day-to-day operations of the food and nutrition services department.

Menus should be planned in advance and followed to ensure nutritional completeness of the diet. Dietitians are tasked with overseeing and approving the facility’s menu and should be actively involved in implementing changes. Residents are always allowed to make menu substitutions, within reason, to better meet their individual preferences.

Food is prepared in a way that preserves nutritive value and palatability. Meals and snacks should be prepared using cooking methods that will not destroy the nutritional quality. In addition, food items should be flavorful and seasoned appropriately.

Residents are offered drinks and beverages to meet hydration needs. This includes water and any other beverages a resident may prefer. Adequate hydration should be a priority and easily available and accessible.

Therapeutic and modified texture diets are ordered by a physician or qualified dietitian. Dietitians may order therapeutic diets if this order-writing privilege is in accordance with state law, facility standards, and has been delegated by the attending physician.

Three meals a day must be provided with no more than 14 hours between dinner and breakfast. Nourishing and substantive meals or snacks should also be provided to residents who wish to eat outside of scheduled dining times. When a substantive evening snack is provided, 16 hours may pass between dinner and breakfast, if agreeable to the resident.

Adaptive utensils and dining equipment should be available at mealtimes to provide assistance to the residents. This could include plate guards, weighted cups, bulked up silverware, postural support, and more. Feeding assistant staff members should also be available when more extensive feeding assistance is needed.

All federal, state, and local food safety guidelines should be followed. Standards relate to food procurement, storage, preparation, holding, and serving. Also included are policies related to cleaning and sanitizing all food-related utensils, cookware, prep areas, and food storage areas. Elderly and immunocompromised individuals are at higher risk of developing foodborne illnesses, so food safety is a top priority in long-term care facilities.

As the healthcare industry evolves with our aging population and the expected changes in applicable federal law, we can expect further changes to the regulations and with that, changes to the demands of the dietitian and associated staff.

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Reference:

CMS State Operations Manual. Appendix PP – Guidance to Surveyors for Long-Term Care Facilities. Revised 02/03/2023. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/Downloads/Appendix-PP-State-Operations-Manual.pdf