Malnutrition and Dehydration in Pennsylvania Nursing Homes

The weight log is the case

Facilities record resident weights on a schedule. A steady decline over months is therefore not a matter of opinion, and the accompanying question is simple: what did the facility do at each point as the number fell?

Expect to see, or to find missing: nutritional assessments, a dietitian referral, a care plan addressing intake, supplements, assistance with eating, and monitoring of what was actually consumed rather than what was delivered.

Why residents stop eating

Rarely because they chose to. Common causes are all preventable or manageable:

• Nobody assists them. Residents who need help to eat may simply not be fed if there is nobody to sit with them. Meal trays delivered and collected untouched is the visible sign.
• Dental and swallowing problems not assessed or acted on.
• Wrong food consistency for someone with dysphagia.
• Medication side effects suppressing appetite, unreviewed.
• Depression, untreated.
• Food that is inedible or culturally unfamiliar, and no alternative offered.

Dehydration is faster and more dangerous

Older adults dehydrate quickly, and the consequences arrive fast: confusion, falls, kidney injury, urinary infection and sometimes hospitalisation. Recurrent urinary tract infections in a resident are frequently a hydration and toileting problem rather than a run of bad luck.

Fluid intake is supposed to be monitored where a resident is at risk. Whether it actually was is a records question.

What to ask for

The weight log for the whole admission, nutritional assessments, dietitian notes and referrals, meal intake records, fluid intake and output records, the care plan and its revisions, and the medication administration record. Ask in writing.

What to watch when you visit

Whether trays are delivered and taken away untouched. Whether anyone sits with residents who need help. Whether water is within reach and whether the jug is full at the end of the day as well as the start.