A focus on nutrition/hydration in LTC facilities post-COVID and recommendations on what to observe during meal service to improve compliance
CMS developed the Quality in Focus Program to help long-term care facilities nationwide promote safe environments. It also aims to educate the public on why regulations in nursing facilities can seem strict, rigid, and often restrictive. Using Quality in Focus as the foundation, Polaris Group will highlight FTag 692 Nutrition/Hydration Status Maintenance. FTag 692 is part of the Nutrition Critical Element Pathway and issues within this regulation could result in deficiencies in 23 related regulatory groups.
The aftermath of COVID-19 has brought confusion, particularly around dining services and meal preparations. As facilities face a resurgence of positive cases, they struggle with vague and inconsistent CMS and CDS guidelines, unlike the clear mandates of 2020 and 2021. Facilities are now relying on local county health departments and corporate nursing officers to navigate what feels like déjà vu—returning to masks, quarantines, and testing.
Unfortunately, surveyors do not consider areas of ambiguity as acceptable or allowable. Meal service must be executed in an efficient, competent, and operative manner. Some residents who were once required to stay in their rooms for meals are still reluctant to exert effort to dress and attend meals in the dining rooms. When meals were served to resident rooms during the COVID crisis, staff who showed up for their shift did all they could just to get trays passed timely. The atmosphere of exasperation lingers in long-term care and meal service is greatly impacted.
We must follow the lead of surveyors. We must discard tight COVID restrictions and acknowledge that one size does not fit all. If residents are not ill or testing positive for COVID-19, their presence in the dining rooms should be encouraged and expected.
Here is what surveyors are looking for related to FTag 692. Reviewing the following elements with your IDT and leadership team will help achieve compliance with this regulation and will promote optimal resident outcomes.
What to observe when meal service is in the dining room:
- Are residents’ hands cleaned before meals?
- Does the diet order on the tray ticket match the physician’s diet order?
- Are residents assisted with set-up, positioning, cueing, and encouragement?
- If residents refuse a meal or choose not to eat, are staff offering substitutes?
- Does the environment promote socialization through table placement, tablemate selection, and meals served by tables?
What to observe when meal service is in resident rooms:
- Are residents positioned upright in their bed or seated comfortably in an appropriate chair?
- Are residents visible from the doorway and do they have their call light within reach?
- Are residents assisted with opening food containers and provided assistive devices to promote independence?
- Do staff offer to provide a substitute if a meal is not consumed? How is the staff informed of substitutes available?
- Is staffing adequate to assist residents who are at risk of choking due to swallowing issues?
In 2023-2024, Polaris consultants conducted mock surveys and found insufficiencies related to FTag 692 in 40% of the facilities surveyed, with several issues reaching a level G or IJ category. Fortunately, the consultants helped these facilities identify real-time action steps to correct and manage these stumbling processes.
For ways to engage your IDT and leadership teams in providing a streamlined meal service process and ultimate dining experience, reach out to Polaris Group to schedule a mock survey for you. For further information contact us today.
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