Long-Term Care Survey Alert

Published on Tue Nov 04, 2003 PDF

Here's what you need to know to proceed.

Feeding assistants may be just the ticket to improving residents' nutritional outcomes in your facility.
 
A new federal regulation recently gave nursing facilities the green light to use paid feeding assistants to feed and cue residents who do not have complicated feeding problems.
 
But before this new brand of assistants can take fork and spoon in hand, they must successfully complete a state-approved training program. "The first step required for facilities to implement a feeding assistant program is for their state to approve a curriculum/training program," says Janet Myder, director of regulatory systems for the American Health Care Association. "Some states are ready to go and must just plug in some details," Myder reports, "and other states have to go to their legislatures for approval before proceeding." Facilities should thus contact their state agencies to find out when the state will be implementing the program, a Centers for Medicare & Medicaid Services official tells Eli.
 
Tip: If your state is slow to implement an approved curriculum, you can still move forward by getting non-nursing staff certified as nursing assistants so they can help residents eat and drink at mealtimes.

Consider Augmenting Training
 
States have some different options for approving a feeding assistant curriculum, according to the final regulation's preamble. They could adopt one curriculum model for facilities to use, or facilities could submit their training program to the state for review and approval.
 
The state-endorsed training     program must, however, meet minimal federal requirements. That   means the program must cover at least the following:

Feeding techniques;

Assistance with feeding and hydration;

Communication and interpersonal skills;

Appropriate responses to resident behavior;

Safety and emergency procedures, including the Heimlich Maneuver;

Infection control; and

Recognizing changes in residents inconsistent with their normal behavior and the importance of reporting those changes to the supervisory nurse.
 
Facilities or states may want to add items to these minimum requirements, according to the regulation. Most feeding assistants will require additional on-the-job training and instructions in helping residents with specific needs, says Annette Kobriger, a nutritional consultant in Chilton, WI. Feeding assistants must work under the supervision of a licensed nurse, according to the regulation. Tip: AHCA is offering a model curriculum for training feeding assistants that matches the federal requirements. Check for more information on the organization's Web site at www.ahca.org.

Assessment Is Key to Success
 
The feeding assistant reg also requires the professional nursing staff to perform what the regulation calls a "comprehensive assessment" to select residents who can be fed safely by non-nursing personnel. The regulation offers little guidance as to what this assessment might involve, but it does say nurses or nurse aides would continue to feed residents with "recurrent lung aspirations, difficulty swallowing, feeding tubes or parenteral/IV feedings."
 
While not required, some facilities may choose to develop standardized protocols for determining which residents can participate in their feeding assistant program. Yet a resident's status can change in an instant, so the impetus will still be on ongoing nursing assessment.
 
"Nurses will also have to take into account the skill level and experience of feeding assistants when assigning them residents," notes Kobriger.