Why Malnutrition and Dehydration Remain Major Issues in Nursing Homes

Malnutrition and dehydration are growing concerns in Tennessee nursing homes, putting elderly residents at serious risk. As facilities face challenges in caring for a rapidly aging population, many residents aren’t getting the proper nutrition or hydration they need. These issues can lead to severe health problems, many of which are preventable.

The Alarming Reality of Malnutrition and Dehydration in Nursing Homes

The extent of malnutrition and dehydration in nursing homes is alarming and often underreported:

• Studies conducted over the last few decades have consistently shown that 35% to 85% of nursing home residents are malnourished [1].
• 30% to 50% of residents are substandard in body weight [2].
• Dehydration is the most common fluid and electrolyte disorder in frail elders, both in long-term care settings and in the community [3].

Perhaps most shocking is that the level of malnutrition in some American nursing homes is similar to that found in many poverty-stricken developing countries, where inadequate food intake is compounded by repeated infections [4].

The Human Cost: More Than Just Numbers

Behind these statistics are real people suffering from preventable conditions. The consequences of malnutrition and dehydration for elderly nursing home residents can be severe:

• Increased risk of infections, including urinary tract infections and pneumonia
• Development of pressure ulcers (bedsores)
• Anemia and hypotension
• Confusion and impaired cognition
• Decreased wound healing
• Increased risk of falls and hip fractures

When malnourished or dehydrated residents are hospitalized for acute illnesses, they face increased morbidity and require longer lengths of stay. Compared to well-nourished residents, they have a five-fold increase in mortality in the hospital [5].

The Root Causes of Malnutrition and Dehydration in TN Nursing Homes

Several factors contribute to the high rates of malnutrition and dehydration in nursing homes:

1. Chronic Health Conditions: Depression, often untreated, occurs in a significant percentage of residents and is linked to weight loss. Nationally, 60% to 70% of nursing home residents are cognitively impaired, many of whom can no longer feed themselves [6].
2. Poor Oral Health: One study found that as many as 70% of residents have untreated dental decay [7]. Many have few or no teeth, and either poorly fitting or no dentures, making eating difficult and unpleasant.
3. Swallowing Disorders: Dysphagia, due to conditions like dementia, stroke, and Parkinson’s disease, affects 40% to 60% of nursing home residents [8].
4. Medication Side Effects: Drugs such as digitalis, psychotropic medications, aspirin, and some antibiotics can decrease appetite or irritate the stomach.
5. Inadequate Staffing: This is perhaps the most critical factor. In one study, each certified nursing assistant (CNA) on the daytime shift typically had seven to nine residents to assist or feed. Evening-shift CNAs were assigned 12 to 15 residents each [9].
6. Lack of Individualized Care: Most nursing homes do not offer residents a choice of foods, and cultural and ethnic food preferences are often ignored.
7. High Staff Turnover: The nursing assistant turnover rate is alarmingly high – 93% per year in some studies [10]. This leads to inconsistent care and a lack of familiarity with residents’ needs.

Nutrition and Hydration Requirements Under the Nursing Home Reform Act

The federal Nursing Home Reform Act of 1987 (NHRA) mandates that facilities meet residents’ nutrition and hydration needs. Key provisions include:

• Maintaining “acceptable parameters of nutritional status” for each resident
• Providing sufficient staffing to meet residents’ needs
• Conducting regular nutritional assessments
• Developing individualized care plans
• Ensuring physician oversight and involvement of other professionals as needed

Despite these requirements, many facilities fall short, either due to negligence or systemic issues like understaffing.

Recognizing the Signs: When to Be Concerned

Family members should be vigilant for these warning signs of malnutrition and dehydration:

• Unexplained weight loss
• Muscle weakness or loss of muscle mass
• Confusion, irritability, or changes in mental status
• Dry skin, sunken eyes, or decreased skin elasticity
• Persistent fatigue or weakness
• Frequent infections or slow wound healing
• Complaints about the food or thirst

What to Do if You Suspect Malnutrition or Dehydration

If you suspect your loved one is suffering from malnutrition or dehydration in a nursing home:

1. Document Everything: Keep detailed notes of your observations, including dates and specific incidents.
2. Communicate with Staff: Express your concerns to nursing staff, dietitians, and facility administrators.
3. Request a Care Plan Meeting: Ask for a formal review of your loved one’s nutritional needs and care plan.
4. Seek Outside Medical Evaluation: Have your family member examined by an independent physician if possible.
5. File a Complaint: If issues persist, file a formal complaint with the Tennessee Department of Health.
6. Consider Legal Action: Consult with an experienced nursing home abuse attorney to understand your rights and options.

How Our Tennessee Nursing Home Abuse and Neglect Attorneys Help

At The Higgins Firm, we hold negligent nursing homes accountable for substandard care. If your loved one has suffered from malnutrition or dehydration due to nursing home neglect, here’s how we can assist:

1. Free Case Evaluation: We’ll review your situation at no cost to determine if you have grounds for a legal claim.
2. Thorough Investigation: Our team will gather medical records, interview witnesses, and consult with medical experts to build a strong case.
3. Regulatory Compliance Check: We’ll investigate whether the nursing home violated federal or state regulations regarding nutrition and hydration.
4. Pursuit of Fair Compensation: We’ll fight for compensation to cover medical expenses, pain and suffering, and other damages resulting from the neglect.
5. Litigation Support: If necessary, we’re prepared to take your case to court to ensure justice is served.

Malnutrition and dehydration in nursing homes are more than just health issues – they’re often indicators of systemic neglect that demand action. As your legal advocates, we at The Higgins Firm are committed to fighting for the rights and well-being of nursing home residents across Tennessee.

If you suspect your loved one is suffering from malnutrition or dehydration in a nursing home, don’t wait to seek help. Call our office or fill out our online form to schedule your free consultation. Together, we can work towards justice, improved care, and a better quality of life for our vulnerable elders.

Remember, proper nutrition and hydration aren’t luxuries – they’re fundamental rights. Let’s stand up for those who can’t always stand up for themselves.

Sources:

[1] Rudman, D., and Feller, A. “Protein-Calorie Undernutrition in the Nursing Home.” Journal of the American Geriatrics Society, 1989, 37(2), p.176.

[2] Rudman, D., Arora, V., Feller, A., et al. “Epidemiology of Malnutrition in Nursing Homes,” in Geriatric Nutrition: A Comprehensive Review, 1990, pp. 325–332.

[3] Kayser-Jones, J., Schell, E., Porter, C., Barbaraccia, J.C., Shaw, H., “Factors Contributing to Dehydration in Nursing Homes: Inadequate Staffing and Lack of Professional Supervision.” Journal of American Geriatrics Society. 1999, 47(10), 1187–1194.

[4] Rudman and Feller, 1989; Rudman, Arora, Feller, et al., 1990.

[5] Kligman, E. and Johnson, J.K., “Prevention of Protein-Calorie Malnutrition in the Elderly Patient.” Geriatric Medicine Today, 1987, 6(3).

[6] National Center for Health Statistics, 1987.

[7] Vigild, M. “Dental Caries and the Need for Treatment among Institutionalized Elderly.” Community Dental Oral Epidemiology, 1989, 17, pp. 102–105.

[8] Steele, C.M., Greenwood, C., Ens, I., Robertson, C., and Seidman-Carlson, R. “Mealtime Difficulties in a Home for the Aged: Not Just Dysphagia.” Dysphagia, 1997, 12, pp. 45–50.

[9] Kayser-Jones and Schell, “The Effect of Staffing on the Quality of Care at Mealtimes.” Nursing Outlook, 1997a, 45(2), pp. 64–72.

[10] American Health Care Association, Facts and Trends, Washington, D.C., 1998.