The new CMS nursing home regulations are coming! Are you ready?

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Carmen Bowman, Owner of Edu-Catering

In July of 2015, CMS proposed and solicited comment on their Reform of Requirements for Long-term Care Facilities. It is anyone’s guess — how much of what was proposed may change due to the many comments submitted. Although there may be changes, and in some cases I hope there are, it is also highly likely that much of what was proposed will remain.

I will highlight the proposed changes related to dining. The great news is that the proposed regulatory changes reflect culture change. CMS has listened! Hopefully every one reading this has already made these changes so compliance with new requirements will be a non-issue. But just in case you still have some work to do, let’s review…

Proposed changes to Food and nutrition services (§483.60) are as follows:
The facility must provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs, taking into consideration the preferences of each resident.

Under Food and drink: Each resident receives and the facility provides —

  • Food that accommodates resident allergies, intolerances, and preferences.
  • Appealing substitutes of similar nutritive value to residents who choose not to eat food that is initially served or who request an alternative meal; and
  • Drinks, including water and other liquids consistent with resident needs and preferences and sufficient to maintain resident hydration.

We’ve been really good at taking allergies into consideration, haven’t we? Have you heard about the smart nursing home resident who didn’t like eggs? She told “the professionals” that she was allergic to them. True story. Intolerances fall into the same category.

Preferences, now we’re talking! Notice our history, the woman who preferred not to eat eggs had to claim allergy to avoid them. Hopefully we’ve made lots of progress here. How is your community doing with discovering and meeting resident preferences? Going a little deeper though, how about ongoing preferences, daily, meal-to-meal? Preferences in real time, not just recorded once on a piece of paper?

You can see that what CMS is getting at now actually goes beyond “substitutes” and “alternatives” to real choices. Hallelujah.

How would you say your home is doing to maintain hydration? Hopefully you go way beyond the typical. What would a “hydration station” be in real life? Let’s give real life to residents — plenty of choices about what to drink.

Under Menus and nutritional adequacy. Menus must
Reflect the religious, cultural and ethnic needs of the residents, as well as input received from residents and resident groups.

And, “Nothing in this paragraph should be construed to limit the resident’s right to make personal dietary choices.”

Do your menus reflect resident preferences and ethnicities? Hopefully this is old news in your community. If not, it’s time for menus to be resident-driven rather than vendor-driven. Notice the BEST part: menus do not limit resident right to choice. This is a welcome and needed change in our regulations. Gone are the days of a citation for a resident who does not like milk not getting milk just because it was on the menu.

Under Frequency of meals,
Each resident must receive and the facility must provide at least three meals daily, at regular times comparable to normal mealtimes in the community or in accordance with resident needs, preferences, requests, and plan of care.

Suitable, nourishing alternative meals and snacks must be available for residents who want to eat at non-traditional times or outside of scheduled meal service times and in accordance with the resident plan of care.

This, too, is a wonderful addition reflective of what changed culture homes already do. Pantries. Snack bars. Refrigerators. Drink bars. Open kitchens. Help yourself. You and I do it in our homes and many communities have figured out how to give this back to residents.

Under Food safety requirements,

  • This provision does not prohibit or prevent facilities from using produce grown in facility gardens, subject to compliance with applicable safe growing and food-handling practices.
  • This provision does not preclude residents from consuming foods not procured by the facility.
  • Store, prepare, distribute, and serve food in accordance with professional standards for food service safety.
  • Have a policy regarding use and storage of foods brought to residents by family and other visitors to ensure safe and sanitary storage, handling, and consumption.

Need some help with what to do next? Pioneer Network has two resources to help you in your quest for compliance with the new requirements. In 2011, the Pioneer Network issued the New Dining Practice Standards. Did you know 12 standard setting clinical organizations agreed to these Standards? Did you know they are based upon research, best practice and CMS regulations? Are you following these new standards of practice? If not, in 2013, the Pioneer Network created the New Dining Standards Toolkit. In it are model policies and procedures including for Safe Gardens, brochures for residents and families, tip sheets for professionals and many more resources. Even better than compliance, these two excellent resources will help you in your quest to serve residents best. And isn’t that where we’re all headed, beyond compliance?!

4 comments on “The new CMS nursing home regulations are coming! Are you ready?

  1. Murali Nair on

    Good Morning,

    Hoping you all doing fine regardless of these pandemic epidemic challenges.

    I would like to know your opinion about the current trends in substituting artificial ingredients in some of the prepared food. Examples like milk and egg substitute in the Nursing Homes. Normally what is the accurate substitute for many of the food in the LTCH menu.
    Thank you and I appreciate your time.
    Murali Nair

    • Joan Devine on

      Murali – hopefully you received my email with some contact information for others who are better able to respond to this.

  2. Brian Bender, PhD on

    I know this is an old post, but I’m just getting up to speed and am curious if these changes persisted? I’m also curious to know if nutritional adequacy is viewed from a top-down approach where all members are given a “nutritionally adequate” menu, or are they personally assessed for malnutrition along any dimension for any feedback between changes and heath outcomes? Thanks for posting!

    • Cathy Lieblich on

      From our colleague, Diane Hall, R.D., President/CEO, BSN Solutions: I am not sure I understand the question fully, but malnutrition will become a major diagnosis in NH because of the new payment model, PDPM. There is talk of needing dietitian coverage on weekends to assure this diagnosis is captured within 72 hours of admissions.
      “Nutritionally adequate” is based on national guidelines and those states that require a dietitian to review and sign off on menus, are guaranteed to have adequate menus. Not all states have this requirement. If you have more questions, please contact Diane at .

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