New Rule Allows “Feeding Assistants” in Nursing Homes
WASHINGTON, D.C. — October 1, 2003 — A new rule allows lower–paid “feeding assistants,” rather than nurse’s aides, to help nursing home residents who cannot eat without assistance. A feeding assistant must complete only eight hours of state–approved training, according to the rule. In contrast, nurse’s aides undergo more rigorous 75–hour training programs that develop basic nursing skills as well as personal care and communication skills. The nurse’s aide course also discusses infection control, emergency procedures, mental health and social service needs, residents’ rights, the care of mentally impaired residents, and basic restorative services.
Anyone may take the 8–hour training course to become a feeding assistant, including nursing home housekeepers or clerical staff. The course must include information about feeding techniques, hydration, and emergency procedures, but need not cover basic nursing skills. Feeding assistants are not supposed to feed residents with complicated eating problems such as difficulty swallowing. The charge nurse determines which residents have such problems.
A registered nurse (RN) or a licensed practical nurse (LPN) must supervise the feeding assistant. The original rule required that the RN or LPN provide “direct” supervision. That language was deleted, as was any requirement that the supervising nurse be on the same floor as the feeding assistant when he or she is helping a resident to eat. Instead, in case of an emergency, the feeding assistant must call the supervisory nurse for help on the resident call system.
Consumer Groups and Lawmakers Criticize Feeding Assistant Program
The Centers for Medicare and Medicaid Services wrote the feeding assistant rule, which will become effective on October 27, 2003. (For the full text, see Federal Register, scroll to 2003, Volume 68, search on “feeding assistant nursing home” and click on the first entry, “Medicaid and Medicare Programs: Requirements for Paid Feeding”). During a public comment period on the rule, these concerns were raised:
- Poorly trained feeding assistants may endanger nursing home residents. They may take actions that are beyond their scope of training or be unable to handle emergency situations.
- State survey agencies should use a special investigative procedure to ensure that the appropriate number of RNs and LPNs are available to supervise feeding assistants.
- Feeding assistants are expected to feed some nursing home residents in their rooms without direct supervision.
- The training course for feeding assistants is too short and need not be given by a licensed health care professional. Feeding assistants need not pass a written competency test after taking the course.
Various consumer groups, including the American Association of Retired Persons (AARP) and the Alzheimer’s Association, have come out against the new rule. The director of federal affairs for AARP, David M. Certner, said it would cause “real harm to nursing home residents” (New York Times, September 24, 2003).
The National Citizens’ Coalition for Nursing Home Reform has been particularly vocal in its opposition, calling the feeding assistant program a “cynical attempt to avoid the nation’s nursing home staffing crisis and related problems like resident malnutrition and dehydration” (Donna R. Lenhoff, executive director, News Release, September 26, 2003). According to Ms. Lenhoff, the rule “would permit a 16–year–old on a wing without a single licensed nurse to perform the Heimlich maneuver on your 90–year–old grandmother if she choked. [What] if she continued to choke or went into cardiac arrest? The rule says this 16–year–old with eight hours of training in nursing care should ring the call bell for a nurse.” The group then points out that nursing home workers often fail to answer call bells promptly.
Rep. Henry Waxman (D–CA), ranking member of the Committee on Government Reform, and Sen. Chuck Grassley (R–IA), chairman of the Committee on Finance, also oppose the feeding assistant rule. In a letter to the Secretary of Human and Health Services, they decry the use of “poorly trained, poorly screened, and poorly supervised workers to handle feeding responsibilities.” “…The regulation does nothing to solve the problem of understaffing in nursing homes,” they wrote. “In fact, the feeding assistant regulation may actually worsen the problem of understaffing by encouraging nursing homes to hire low–wage feeding assistants, instead of certified nurse’s aides.”
Malnutrition and Feeding Issues in Nursing Homes
The United States has 17,000 nursing homes serving 1.6 million people (Administration on Aging, Center for Communication and Consumer Services). One review estimates that 35% to 85% of nursing home residents suffer from malnutrition, and that 30% to 50% have substandard body weight. To compound the problem, many elderly nursing home residents cannot feed themselves due to frailty, mental impairment, swallowing difficulties, poor control of their hands and arms, poor teeth, or ill–fitting dentures. Caring for those who cannot eat without assistance takes time and energy, traits in short supply in a nursing home that is understaffed. (See Nursing Home Abuse: Inadequate Staffing for more details).
The nursing home industry supports the feeding assistant rule, viewing it as a panacea for its understaffing problems and a better way to ensure that nursing home residents receive adequate nutrition. Others say, however, that the focus should be on hiring skilled nursing home workers at better salaries and finding ways to keep them employed.
At Brayton Purcell, we are concerned about the health and safety of the elderly in nursing homes, including their nutritional needs. If you have questions about the legal rights of an elderly loved one and nursing home neglect, please contact us. We are experienced in all areas of elder abuse law, including neglect and inadequate pain management issues.
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