Let’s Get DIETARY!

Appropriately caring for residents covers many different areas. Today, we are going to focus on 59A-36.007 (1) (a) in accordance with rule 59A-36.012, F.A.C.

59A-36.007 Resident Care Standards
(1) SUPERVISION. Facilities must offer personal supervision as appropriate for each resident, including the following:
(a) Monitoring of the quantity and quality of resident diets in accordance with rule 59A-36.012, F.A.C.

Once a resident is under the care of your ALF, it becomes your responsibility to 1) make sure the resident is being served nutritious meals and 2) monitor the resident’s eating habits.

There are many regulations – and opportunities for mistakes – when it comes to providing nutritious meals.

Meal Planning a.k.a. You Need a Dietitian

In order to simplify this and ensure meals are planned correctly, the regulations state that the meals served in your assisted living facility must be planned based on the current USDA Dietary Guidelines for Americans, 2010, https://health.gov/sites/default/files/2020-01/DietaryGuidelines2010.pdf and the current summary of Dietary Reference Intakes established by the Food and Nutrition Board of the Institute of Medicine of the National Academies, 2010 which can be found at https://www.nationalacademies.org/our-work/summary-report-of-the-dietary-reference-intakes
Clearly, there is a whole lot of data to review in order to ensure you are meeting the requirements of your residents’ standard and therapeutic diets, which include specifics on both the nutrition values and portion sizes. The State does not expect you to interpret all of this on your own.

By regulation, all regular and therapeutic menus must be reviewed annually by one of the following: a licensed or registered dietitian, a licensed nutritionist, or a registered dietetic technician supervised by a licensed or registered dietitian, or a licensed nutritionist to ensure the meals meet the nutritional standards established in this regulation. The annual review must be documented in the facility files and include the original signature of the reviewer, registration or license number, and date reviewed. Portion sizes must be indicated on the menus or on a separate sheet. This dietary professional is also usually able to provide staff with the required Food Service CEU, something for you to consider when contracting their services.
But wait, there’s more!
If your ALF is licensed for 16 or more residents, your approved menu must also include standardized recipes for each meal item.
The United States Department of Agriculture (USDA) identifies that a standardized recipe “has been found to produce the same good results and yield every time when the exact procedures are used with the same type of equipment and the same quantity and quality of ingredients”. Here is what a standard recipe must include and how to create one. https://education.mn.gov/mdeprod/idcplg?IdcService=GET_FILE&dDocName=057472&RevisionSelectionMethod=latestReleased&Rendition=primary Standard recipes can also be easily found online.

In any population these days, you will find people on “therapeutic” diets. These are diets that have been recommended by a healthcare professional due to a medical condition and may include Diabetic, High fiber, Mechanically softened, etc. It is extremely important that the residents in 1823 reflect the special diet. You must also put a system or I would recommend policy and procedure in place that outlines how your staff will be made aware of special diets and how staff will remember and make sure those residents are served the special diets. There is no right or wrong answer when it comes to this however it is important to protect the resident’s dignity and privacy. For example, taping a label at the resident’s sitting area labeled “Diabetic” is not allowed. The facility must document a resident’s refusal to comply with a therapeutic diet and provide notification to the resident’s health care provider of such refusal.

The facility staff must also supervise the resident’s eating habits as this can be key in identifying health issues and obtaining medical care. Underlying medical conditions often suppress appetite and they want to eat. I highly recommend policy and procedure be put in place and inservice staff regarding the observation of the resident’s eating intake. If a resident suddenly isn’t hungry at meals, stops enjoying foods s/he once loved, or otherwise exhibits changes that may affect their nutritional intake, it is important to note this and advise their healthcare provider.

Weighing residents is also a key tool to identify nutritional concerns. The regulation states A weight record which is initiated on admission Residents receiving assistance with the activities of daily living shall have their weight recorded semi-annually. Meaning your ALF must weigh a resident when they are first admitted to the ALF and once every six months. I highly recommend that you weigh your residents every month in order to help identify possible health issues. This is a good time to check in with them individually and, given the rise of telehealth, it is a good thing to have on record, changes, or not.

It is also a regulation that your ALF encourages resident participation in menu planning.”Residents must be encouraged to participate in menu planning” In order for your ALF to be in compliance, it is important to determine how you will meet the regulation. Encouraging residents to participate can be done in a few ways.
Resident Council Meetings
Suggestion Box
Or anyway that you feel is an effective way to get resident feedback regarding menu planning.

Whichever way that you choose to meet the regulation, it is a must that you document the participation or non-participation. I highly recommend that you also create a policy and procedure outlining your procedure to encourage resident participation with menu planning.

Menus must also be dated and planned at least 1 week in advance for both regular and therapeutic diets. Planned menus must be conspicuously posted or, at least, easily available to residents. Regular and therapeutic menus as served, with substitutions noted before or when the meal is served, must be kept on file in the facility for 6 months.

As you can see making sure you are in compliance with  (a) Monitoring of the quantity and quality of resident diets in accordance with rule 59A-36.012, F.A.C. includes a lot of ground. I suggest you take the time and evaluate each requirement and make sure your ALF is in compliance.