Your long term care questions.

Discussion in 'Health Care' started by btthegreat, Jun 15, 2021.

  1. btthegreat

    btthegreat Well-Known Member

    Joined:
    May 30, 2010
    Messages:
    14,317
    Likes Received:
    5,623
    Trophy Points:
    113
    I am a Certified Dietary Manager who has worked in nursing homes, memory care and assisted living facilities for decades. I have some limited understanding of how these facilities work, how they are structured to meet medicaid and medicare regulations etc, and much a deeper understanding of how these kitchens and dining programs work. I know the diets/ texture modifications, assessments, nutrition screens are written etc, why the menus written are the way they are etc.

    If you have questions about any of this, I am willing to answer based on my experience and training.

    I also know what I do NOT KNOW, so lets not get into why your Mom was prescribed drug X or why the physical therapist decreased the number of scheduled minutes or visits for your uncle.
     
    Last edited: Jun 15, 2021
  2. MJ Davies

    MJ Davies Well-Known Member

    Joined:
    Jun 4, 2020
    Messages:
    13,377
    Likes Received:
    12,748
    Trophy Points:
    113
    Are you in the US?
     
  3. btthegreat

    btthegreat Well-Known Member

    Joined:
    May 30, 2010
    Messages:
    14,317
    Likes Received:
    5,623
    Trophy Points:
    113
    Yes. I live in Oregon. those Medicaid and Medicare regulations that are measured for compliance with annual or complaint CMS surveys are based federal guidelines with each states tweaking them as well.
     
    MJ Davies likes this.
  4. MJ Davies

    MJ Davies Well-Known Member

    Joined:
    Jun 4, 2020
    Messages:
    13,377
    Likes Received:
    12,748
    Trophy Points:
    113
    A friend overseas recently went through something with her step-son so the rules are probably different where they are but I'm curious to hear your take on this. He is in his late teens/early 20s and has some of condition where he can't tolerate different textures of foods so he goes on hunger strikes unless someone (usually his mother or grandmother) prepares what he wants and delivers it to the facility where he lives. He's been put out of three facilities thus far.

    My questions are:

    1. Is there a "master menu plan" for long-term care facilities and who decides what that is?

    2. I understand why facilities can't cater to each resident's food choices, but are there some kind of alternate menu plans (eg. vegetarian, gluter-free, organic, etc.) in which they have some wiggle room?

    3. I understand why a facility doesn't want the liability of a resident that refuses to eat. Is there some kind of upper limit or gauge (ie. #meals missed, weight loss, malnutrition, etc.). that dictates expulsion or is this at the discretion of the individual facility Director?

    4. How often are menu plans changed? (I knew a guy who was in a mental health hospital for several months. He said they had the exact same menu every week).

    5. How often are facilities inspected (and are they blind or scheduled)?
     
  5. btthegreat

    btthegreat Well-Known Member

    Joined:
    May 30, 2010
    Messages:
    14,317
    Likes Received:
    5,623
    Trophy Points:
    113
    First I have to discuss this business of expelling a resident because he is going on a 'hunger strike'. In my opinion, its outrageous conduct. You do not expel someone for deciding not to eat. And there is no inherent liability as long as you have made appropriate efforts to assess the reason, meet his needs, implement some interventions that encourage intake, you have informed the doctor, involved a dietician if appropriate etc. You have to cover your backside with your clinical documentation, and then you honor his choice not to eat.

    If the reason is because his needs are so specialized that you feel another level of care, or facility will better handle it, you document your efforts to place him in a setting that will work better. For example if he is not eating because he needs a strict Kosher kitchen for religious reason, and yours is not and you have not advertised it as able to provide a strict kosher diet, then you would have to offer him access to resources to choose place that can provide that. If he is not eating and has a diagnosis of severe schizophrenia that you think is contributing to his poor intake, you had better have made an appointment with a psychiatrist to evaluate his treatment plan. If he hasn't got an appetite, you have to document your efforts to find out why. But one of the rights every resident has, is to refuse care, meds or nutrition. PERIOD!

    1. There is not a 'master menu'.. A registered dietician has to either write or sign off on a facility 'menu' that is consistent with RDA guidelines for the micro and macro nutrient needs of geriatric care, as modified by any diet or texture offered by the facility. These are often sold to the company with the recipes, breakdowns etc included in the package. Common diets include 'Consistent Carbohydrate' (for diabetics) NAS and 2gm Sod ( for cardiac liver or renal patients) High calorie or high protein ( for residents with unintended wt loss, decub ulcers, an amputation etc), Increasing or decreasing fluid,puree or mechanically altered diets ( chewing or swallowing problems).

    2.Facilities are required to offer at least one alternate option (usually they offer more) in case a resident dislikes or cannot handle the daily 'special'. If Mr. Jones does not like the Spaghetti, or he is gluten intolerant, or allergic to tomatoes, you have to provide alternatives, maybe some beef stew, or an egg salad sandwich, or a cottage cheese and fruit plate. If he cannot chew the pasta, or chokes on the pieces of tomato, you will probably have to puree it in any nursing or memory care setting.

    You have to provide the diets that a doctor orders for any patient within your capacity. If there is no 1200 calorie diet offered, and it is unrealistic for the dietician modify and adapt the menu, then the doctor is faxed so he either modifies the order to an 1800 calorie or resident has to find somewhere that promises to accomodate his special needs.

    3. There is no set rule on when you have to change your menus or how often you can put the same food on the menu. Most often there is a weekly menu that rotates from weeks 1-4 or five through spring and summer months and another menu that rotates for fall and winter. In addition you will have all those alternate menu options to pick from. Many facilities will have a 'drop down menu system', so that facilities can individualize this. Maybe the main entree is 'Beef liver and onions' and its very unpopular in your building, you can click a button and get a series of options to replace that entree on your printed menus to Beef cube steak and gravy, or Meatloaf. Breakfast tends to have the most duplicative foods. You will see eggs offered most days, maybe bacon twice a week, sausage three times, and ham once. There will be pancakes or waffles twice, maybe a baked omelette, or biscuits and gravy once a week as well.

    4. Facilities are inspected annually for their yearly survey which covers literally everything included under the medicaid/medicare rules. The states are provided a 4 month window in which to complete this annual inspection to avoid fines. They are 'blind' in the sense that nobody gets told when in that 'window' these inspectors are showing up. The inspections last around 4 days, unless it starts looking real ugly!. there are also complaint surveys, where CMS receives a complaint and has to come in and investigate the complaint to see if it has merit..
     
    Last edited: Jun 15, 2021
  6. Moonglow

    Moonglow Well-Known Member

    Joined:
    Nov 19, 2013
    Messages:
    18,329
    Likes Received:
    6,696
    Trophy Points:
    113
    Gender:
    Male
    Do they let you smoke weed or dabs while in a nursing home?
     
  7. Moonglow

    Moonglow Well-Known Member

    Joined:
    Nov 19, 2013
    Messages:
    18,329
    Likes Received:
    6,696
    Trophy Points:
    113
    Gender:
    Male
    Why do many nursing homes stink?
     
  8. btthegreat

    btthegreat Well-Known Member

    Joined:
    May 30, 2010
    Messages:
    14,317
    Likes Received:
    5,623
    Trophy Points:
    113
    You can't smoke anything within the building for fire hazard reasons. There may be a smoking area provided outside in a covered area but its not likely you get to smoke weed on the property.
    That would depend on whether it is legal, and whether the particular facility has a policy on weed. I have never worked for one that did, primarily because few states have legalized it, and there is the issue of contact highs with other residents who's medications and orders are not consistent with pot smoke permeating the halls.
     
    Last edited: Jun 15, 2021
  9. Moonglow

    Moonglow Well-Known Member

    Joined:
    Nov 19, 2013
    Messages:
    18,329
    Likes Received:
    6,696
    Trophy Points:
    113
    Gender:
    Male
    Just like the cigarette smokers there would be a place to smoke with ventilation. If not they can forget my patronage.
     
    Last edited: Jun 15, 2021
  10. btthegreat

    btthegreat Well-Known Member

    Joined:
    May 30, 2010
    Messages:
    14,317
    Likes Received:
    5,623
    Trophy Points:
    113
    the facility writes its policies, but none of them will include one for the illegal consumption of drugs, and few will provide one even if its legal. There are too many liability concerns and not a lot of doctors will write an order for maryjane usage.
     
  11. Moonglow

    Moonglow Well-Known Member

    Joined:
    Nov 19, 2013
    Messages:
    18,329
    Likes Received:
    6,696
    Trophy Points:
    113
    Gender:
    Male
    I have a prescription for mine so it must be legal.
     
  12. btthegreat

    btthegreat Well-Known Member

    Joined:
    May 30, 2010
    Messages:
    14,317
    Likes Received:
    5,623
    Trophy Points:
    113
    There are states that have a medical exception for pot use with a prescription, including mine but the feds are still behind the eight ball here. Therefore companies are free to write their own policy to comply with that your request, or refuse to and offer to help with a discharge plan elsewhere if you can find one that will honor that medical card on premise.
     
    Last edited: Jun 15, 2021

Share This Page