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Utilization of Feeding Tubes for Elderly Residents of Nursing Homes Requires Close Monitoring for Satisfaction of Nutritional Needs and Avoidance of Complications

If your loved one currently resides in a Skilled Nursing Facility (SNF) or nursing home in Southern California, and has problems receiving adequate nutrition, you may have considered whether your loved one should use a feeding tube.

According to a recent article titled Enteral Nutrition for Older Adults in Nursing Facilities, published in the June 2011 volume of Nutrition in Clinical Practice, older adults (those 85 years of age and older) residing in nursing facilities tend to have multiple health conditions and an increased need of assistance with activities of daily living, such as eating. Approximately fifteen percent of residents of nursing facilities need constant assistance with eating. Thirty-two percent of residents have sensory impairments, including problems with teeth, which hinder eating.

It is the responsibility of the healthcare practitioners at nursing facilities, including physicians, nurses, and dieticians, to ensure that residents receive adequate nutrition. One of the methods used to ensure that residents are receiving adequate nutrition is for those residents to rely on feeding tubes. If a feeding tube is used, the registered dietician (RD) often determines the nutritional requirements of each resident and ensures that each resident’s nutritional needs are met. Failure to monitor the nutritional intake of residents can lead to malnutrition, which in turn can lead to weight loss, pressure ulcers, and other fatal problems. These injuries are often signs of neglect.

According to federal regulations, use of a feeding tube should not automatically be the preferred option for residents not receiving adequate nutrition. Before a feeding tube is placed, the nursing facility must ensure that 1) the use of a feeding tube is unavoidable for those who have been able to eat with or without assistance, and 2) residents receiving nutrition through feeding tubes receive attention and treatment to prevent complications, such as aspiration pneumonia, vomiting, and dehydration, and to restore normal eating abilities, if possible. (42 C.F.R. § 483.25(g).)

The authors of the article state that the resident’s wishes regarding the use of a feeding should be respected. The resident may have expressed his or her preferences when admitted to the nursing facility, in an advanced directive, or a living will. If no preferences can be determined, then a decision has to be made on whether use of a feeding tube is worthwhile. Feeding tubes are appropriate in various situations, including 1) when a return to previous quality of life is expected, 2) when a resident has a permanent problem swallowing or has a damaged esophagus, and 3) for people with head and neck cancer or acute stroke with dysphagia as a possible method to prolong life.

In a nursing facility, the RD is responsible for assessing the nutritional needs of residents, tailoring the formula residents receive through the feeding tube based on those needs, and changing the tube feeding orders as needed. The RD, along with the healthcare team, should continually monitor the effectiveness of the tube feeding, including formula administration, tolerance of the feeding, nutrition status, and overall health and well-being. Proper monitoring will reduce the incidence and severity of complications as a result of tube feeding, including clogging, aspiration pneumonia, and diarrhea.

It is important for family members to follow up with the staff of the nursing facility, especially the registered dietician, in deciding the best course of action for their loved ones with respect to nutrition. This is particularly important if the resident does not have the capacity to express preferences regarding the use of feeding tubes. Following up with the nursing staff regarding tube feeding will help ensure that the staff has the best interests of your loved one in mind and is following through with their care plans.

If your loved one has suffered from malnutrition or other injuries because a nursing home in Riverside, San Bernardino, Fontana, Ontario, or Corona failed to adequately monitor the nutritional intake received by your loved one, please contact us today to see how we can help your loved one receive the care to which he or she is entitled.