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Senate Panel Told Of Malnutrition In Nursing Homes Poor Staffing, Menu Selection Among Threats To Eating Habits

Some nursing home residents are malnourished and dying not because they refuse to eat - but because staff members rush them through meals, health care experts said at a Senate forum on Wednesday.

“When we think of people going to bed hungry, many of us tend to think of people in developing countries,” said Jeanie Kayser-Jones, a professor of nursing and medical anthropology at the University of California at San Francisco, who studied 100 nursing-home residents who weren’t eating well.

“In some American nursing homes people also go to bed hungry, not because food is unavailable but because, among other factors, no one takes the time to feed them.”

When residents ate slowly, some aides at an unidentified nursing home mixed pureed food - meat, vegetables, potatoes and ice cream - together in glasses of milk and forced residents to drink their meals quickly, Kayser-Jones said.

Some nursing home residents also are in danger of becoming severely dehydrated because they simply aren’t given enough to drink, she said. One 89-year-old woman who had to be hospitalized was so dehydrated that her tongue was stuck to the roof of her mouth, she said.

The forum on the risk of malnutrition in nursing homes was called by Sen. Charles Grassley, R-Iowa, chairman of the Senate Special Committee on Aging. The 1987 national Nursing Home Reform Act has led to improvements in nursing homes, he said, yet a decade later “problems still remain.” The forum was to explore the threat to America’s seniors to see if new national legislation is needed, he said.

Kayser-Jones, the lead panelist, said four main factors harm residents’ eating habits: a lack of attention to what foods individuals like, including a lack of ethnic food; undiagnosed swallowing disorders; poor oral health; and, probably most of all, too little staff to help residents eat.

“I have nine residents to feed tonight,” Kayser-Jones quoted an anonymous nurse aide. “Sometimes I can feed two patients together, one in the middle bed and one in the bed by the window. If you don’t feed them, they don’t eat. We need more helpers at dinner time.”

And a 97-year-old woman: “They have maybe half a dozen people to feed at once, so I don’t get much attention. I think everybody is doing the best they can, but they are too fast.”

Grassley cited an article in the current Time magazine that reported that of all Californians who died in nursing homes from 1986 through 1993, more than 7 percent of them succumbed, at least in part, to neglect, including lack of food and water. “If the rest of America’s 1.6 million nursing-home residents are dying of questionable causes at the same rate as in California, it means that every year about 35,000 Americans are dying prematurely, or in unnecessary pain, or both,” Time reported.

Anna Malloy lost 24 pounds within 10 months of entering a nursing home, her son, Joseph Malloy of Clinton, Md., said at the forum. She developed a bedsore that got infected, and the infection went clear to the bone, requiring her to have a three-hour operation on her right hip. The surgeon told Joseph Malloy that the whole thing could have been avoided if she had been turned properly and given the right amount of food and liquids.

“One day, I arrived during lunchtime and asked why Mother hadn’t been offered any liquid,” Malloy said. “The aide said: ‘You feed her. There are only two aides for 64 patients.”’

xxxx LOOKING FOR SIGNS By Jill Young Miller Sun-Sentinel, South Florida If you have a loved one in a nursing home, here are some things to watch for: Whether residents are fed in bed or in the dining room. They tend to enjoy their meals more, and eat more, in dining rooms. Whether the dining room is pleasant or chaotic. Whether staff members position residents who must eat in their rooms upright or feed them while they’re semi-reclined. Whether residents are fed quickly and forcefully. Many have difficulty swallowing and could choke or develop aspiration pneumonia. Whether food is palatable. Whether residents are helped with oral hygiene after meals. Whether staff members talk down to residents, ordering them to open their mouths, not to talk, to eat. Whether aides are well supervised by a professional nursing staff at mealtime. If you feel something is amiss, you should: Share what you found with the staff of the nursing home. Ask for a care-planning conference right away. Monitor your family member or friend to make sure they get the care they need. If all else fails, file a complaint with a state health agency.


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