I visited a friend in a nursing home yesterday and they brought her dinner, and left it. Is this standard practice?

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I visited a friend in a nursing home yesterday and they brought her dinner, and left it. Is this standard practice?

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Countrymouse is correct: Mostly likely, when assessed at admission, the lady was recorded as being able to eat and drink without assistance.

If this is what is recorded in her chart, then the aides are not obligated to try to feed her. She would need to be examined by a physician and have her ADL status changed to "full feed" if that is what she needs. Most likely, as her disease has progressed, she has forgotten how to feed herself.

Unfortunately, having worked as a CNA previously, there were often not enough staff working to ensure that all those with feeds actually were fed. It was not my original plan, but one week I had to start "rationing" who would get fed on which evening so that at least somebody was fed supper every-other-day. I was assigned 16 total care patients - and there was only one of me. I could not feed more than 8 during my shift because it took me an hour per patient. You do the math. Also, the trays were whisked away at a certain time, so if you did not get some food into the patient, then they did not eat a meal. Yes, I complained about it to my charge nurse.

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Spouse has been in snf 4 years and this past year is no longer able to feed himself. Swallowing, inability to hold cups and utensils and possibly some dementia are contributing factors. Under staffing is a major reason resident's needs go unmet. His foods are now pureed and it's a challenge to get him to eat much of the pasty textured foods. He still likes to eat though. It breaks my heart when I feed him as this is not something he wished upon either of us.
His Advance Directives specify no tubes, CPR, kidney dialysis. The facility and doctor have asked me several times about the feeding by tubes and I have said absolutely not. I have been asked to sign an additional document to reaffirm his wishes and that I will carry through as he wants. Tubes would be easier on staffing and less stressful to overworked staff whom I'm sure would be fired if he choked to death. I fear watching him die in a choking fit, but I can not go against his wishes. Equipment is kept bedside to clear his throat if needed as this falls short of intubation and CPR.
A CNA is assigned to feed him at every meal. If I'm there to help, his tray is generally brought sooner and I feed him. Otherwise it's about a 30 min. wait. I realize it's so lonely to be in a bedside having to eat alone so I try to be there.
Another thing with CNAs: They really work so hard for mostly no thanks yet lots of criticism. In the 4 years my spouse has been there, I've only complained about 1 CNA who rode in the van as escort to a medical appointment. She did not respect our right to not have her present in the room with the nurse and doctor. It got worse from that moment forward. I told the nurse supervisor to not let her travel to his appointments again. I went one step furthur and told her she needs to train her staff that if families say to not enter the treatment area, that's the way it is. I directed most of my anger to the charge nurse as I think she tells her CNAs to go into the appointment room. This is appropriate when no family is present. If family wants CNA in the room that's OK. Though I would actually like the CNA to come in with us, it is not what my spouse wants, and his wishes trump that of others.
Otherwise, I always tell management whenever I'm at meetings that I think staff does very well handling him.
Bless anyone who even tries to do CNA work!

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I live in a health care facility and I have seen and heard it all. The turnover is extremely high, staff is constantly short-handed and has to be in ten places at once taking care of many people. They just simply don't have the time to do this although they should. In some cases, perhaps with very strong, legal demands from the family or a doctor, sometimes they will feed someone but don't count on it.

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I'm appalled at all the people who say that those who can't feed themselves are left to do without! Mom's nursing home had several people who needed to be fed and many more who needed to be encouraged and supervised, all of them were in the dining room under the care of a PSW. Every meal was charted. Modified diets and supplements were given as needed. The general rule of thumb was to offer 3 times before accepting a refusal. I can see people slipping through the cracks in AL because people there are expected to be self determinate, but a nursing home is supposed to be about full care!

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I’m appalled too but I witnessed it with my FIL. Except his issue was extreme difficulty swallowing. He was served meals in his room and no one helped him to eat. I don’t know even know if it would have made a difference if they had, though.

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From what I have seen, unless the resident is still sharp mentally, or has friends or family members who check on him/her routinely and serve as advocates, the needs of the resident tend to get overlooked or forgotten. The staff get busy, there is often considerable turnover, and "corners start getting cut".

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Tell the staff you don't care if anybody's busy or not.

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Yes...when my mother was in SNF for 10 months, I came every day & brought different things from home that she liked to eat. I’ve at times come & she had plate of food in front of her untouched with nobody to help her. She didn’t like the food & the bones by her neck & shoulders were starting to show. Another time I came & her tray was nowhere near her...she couldn’t reach it if she tried. I yelled at Aide who did that & demanded explanation...another Senior CNA came in to “smooth things over “ & say she thought I was coming & I would help her” & that she is not the regular Aide, blah, blah, blah, After I took her home, she ate better & now her bones don’t show. It’s hard work..but if there’s someone in family who can’t do this, then they should have care plan meeting & insist she have someone to help her eat. If she has trouble swallowing, she needs purée foods. Also Ensure drinks. She may be entitled to Hospice Aide to help her during a meal time. Hope this helps. Hugs 🤗

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The nursing home that my mother lived in for four years had a wide variety of residents with regard to feeding ability. We consistently saw this having trouble being helped to eat. Anytime there was someone who had issues with swallowing they were referred for a video fluoroscopy, often termed a swallow study. Your friend is being neglected but that doesn’t mean it’s the standard everywhere

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She is "skin and bones" because she is not being fed. Yes--if family is not there to feed the patient they will just take it away and chart "refused" and be done with it so the patients slowly starve -- none of the CNAs have time to feed each patient. Before I had mom's feeding tube put in, it would take me close to 2 hours to feed her a single meal, and with enormous difficulty. She eventually needed a feeding tube due to kidney failure from DEHYDRATION; it would take me all day even to get a cup of water in her, one teaspoon at a time. She's doing great with her feeding tube!

If family is not involved with the care the patient will die very slowly.

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Sadly to say, I did my clinicals in a nursing facility. I watched how the nurses would leave dinner and not try to assist the ones who could not feed themselves. (they were lazy and heartless)

My dad had to go to the facility where his mom was and he had to feed her or she wouldn't have gotten fed. Sad but true.

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Possibly because you were there. I know that when I visited my step father and he wanted to eat in his apartment, they just delivered the food and left. Normally, he goes to the dining room, but, he wanted to talk to me in private, he is basically deaf, so hollering at him in the dining room would not have been good!

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My father was among the fortunate who was lovingly spoon fed. Even with that level of care, his swallow reflex was compromised and he often refused the spoon. He lost weight til skeletal because of protein deficiency disease. Hospice explained to me that no matter what nutrients were received by his body, the body would not absorb the nutrients. My father did not want a feeding tube. He hung on forever in that state and it was horrible to watch. My mother died at 63 pounds, same failure to thrive process.

Your compassion and caring are why we all come to AC looking for hope and sanity. Please follow the wise advice here, but realize for many, death can look like the cruelest factory of neglect and hardened caregiving. In an unfortunate many cases, it is. We haven't figured out how to comfort millions 24/7 yet. It kills me to live with these images. Follow your best instincts, and take care of yourself because we need your caring and best thinking. I am so grateful for AC. My father died July 18 at 98.

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That is *NOT* true-- because hospice ARNP of Cornerstone in Central Florida said the same LIE to me, that mom's body was shutting down which was why she does not want to eat. Well, with Alzheimer's they forget how to eat, but their body still needs fluids and nourishment. I could not stand to watch mom die of dehydration which can take 3 weeks, so I revoked her hospice and got a feeding tube put in her, which only took the surgeon about 10 minutes to do. No complications for her. Not only has her kidneys went back to normal (she was in kidney failure due to dehydration), her immune system returned back to normal from the nutrition and fluids. Hospice will let patients slowly die in agony for two or even three long weeks, and just because they can't answer you does not mean they are not suffering. Wow. PS: I got her hospice reinstated at discharge from the hospital and it was very easy to do. Mom will be 90 soon because of the feeding tube; hospice takes patients with feeding tubes if pre-existing. Since it was a new admission this is technically pre-existing. SInce mom is kept hydrated she no longer has issues with urinary tract infections, but the Alzheimer's cannot be cured.

Let me assure you her body assimilates nutrition and fluids very well, when the ARNP at Cornerstone of Central Florida said her body would not do so. She LIED to me.

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quiltin, she’s lucky to have another person who was able to stop in and see how things are. To all the good stuff before this, I’d add: let’s not discount the brother all together, the sister hopefully tells him too, and he’s more alert and may check in more often for a while.

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It is common, but it is disgracefully bad practice.

I don't doubt that when assessed at admission the lady was recorded as being able to eat and drink without assistance. And then you have to ask, has anyone checked since?

There should be a record of her intake but from the sound of it this is not the kind of nursing home where you'd expect it to be reliable.

You have absolutely done the right thing in speaking up, and I'm glad the lady's daughter got a positive response to her enquiry; but unless this is followed up I am afraid the lady will indeed not be long for this world (of course it's possible she won't be anyway, I haven't been to check our OP's profile).

It depends on how much you're willing to do, but for the sake of other and future residents I'd be inclined to check out the NH's inspection reports, see if there's anything enlightening on those, and then report your concerns to whoever is responsible for long term and residential care standards in the area.

Nursing homes are often chronically understaffed by overstretched, poorly paid and minimally trained workers. It will likely always remain a problem. But just a little initiative and imagination can make a difference: for example, is there no volunteer group, who might be asked to help at mealtimes? If not, why not ask the activities director to organise one? You need a few strict ground rules about hygiene and following protocols, but it shouldn't be that hard to get a group going.

And, by the way, if the lady is so very immobile I'd also be inclined to ask if she minded my having a quick peep just to see how her skin is doing.

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Me again... Thanks for all your help. I called her daughter and she called the nursing home, and they did say they will help feed her. But she is in Iowa, and her Mom is in Florida. They may also call Hospice. I hope they do what they said they would!

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Good job QIR.

Will you be able to check on her and determine if her weight is stabilizing or increasing?

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I have to say this common in the hospital too. Too many pts and not enough help. I often see pts with a food tray in front of them,, and not a bite is taken, because they can't. I learned from my ILs times in hospital that you better have a family member on site.. Luckily my mom was able to feed her self in rehab, and dad had a lot of help in MC,, but this is not always how it goes.

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I work in dietary in a hospital and if I see a patient with a tray, even if I did not deliver it, I will go in and ask if they need help. If they say yes or appear not to be capable of feeding themselves I get a nurse in. I then go one step further and contact the dietician and let them know the patient is not being fed while the food is fresh. All hospitals have volunteers and the nurses can call on them to help patients that cannot self-feed. No excuses in my book. My question to anyone who complains is "If this was your child, is this how you would want them treated? If you have a lack of staff, you don't punish the patient, you skip your break and work 2x harder.

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I told the staff at NH when mom was there recently for skilled nursing rehab that she needs help cutting food, reaching for things, etc.

The woman in admissions said the staff helps when needed. I was at the NH daily. Sometimes it was mealtime. They just dropped food off when they saw me there.

Some people don’t have visitors. Those people do need help. It is sad.

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It was the same way when i would take my mom to visit her sister in MC for dementia..at first she began in the dining room, but in a short while she could no longer feed herself. If it had not been for ONE granddaughter, she would have died much sooner. If a resident has a visitor, they simply drop off the tray and walk away....and this was in a supposedly “upscale” facility....sad, but true...

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Once my MIL with short-term memory loss went into LTC, she refused to get out of bed even though there was nothing wrong with her. This included meals. She was in a nice but small NH. First private pay, then Medicaid, same place. They allowed her to stay in bed all the time because they can't force her to do things against her will. We recently moved her to a closer NH that is good quality and much bigger. Guess what? Now they get her out of bed to eat in the dining room. When she first moved there and didn't get out of bed to eat, she allegedly had a minor "choking" incident because she didn't raise up her bed far enough which made swallowing more difficult. My point is that the home your friend is in probably doesn't have enough staff or are overwhelmed so she's not getting enough oversight.

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Geaton777, there are ways to encourage a resident to mobilize or participate in activities. Sometimes nothing works, but it is much better to say "It's time to ...." rather than "Do you want to...." No one may be forced, but just plain bribes work, too, e.g., small prizes to be won at Bingo games. Who would show up for Bingo if not for the tantalizing possibility of a snack, trinket, or other small prize? Some employees are better than others at encouraging the residents, but most NH are understaffed to the point of breaking even the best employees.

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Whether it is by intention or not it seems they are helping her along. Those who work in these conditions work terribly understaffed and if you did look around while there I know that you recognize that almost everyone needs to be fed. So this comes down to the squeaky wheel getting greased, and those who have family who visit or who might pop in at any moment or who will raise heck when they find this will get the limited care. The people are paid minimum wage and almost always lower than that. It is often backbreaking work, and if it isn't my imagination some like cell phone devices more than work these days. I think that you are correct that this is the end of the line. And this can be unfortunately what it looks like at the end with no family about and with no money. Heartbreaking. Absolutely heartbreaking. I would report what you saw to an ombudsman, and hope they visit at meal time, look at a chart for weight loss, but as you know, the lies will start, and who is to be the judge. So awfully sorry about this.

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Me again. She lives an hour and a half away from me, so I don't see her often. 3 hour round trip. Her son lives near her, but is not very involved. I did tell her sister who lives near me. She was in her room, and they didn't know I would be there. I suspect she is beyond getting in a wheel chair based on her frozen limbs. She was a large woman. I bet she weighs about 110 now. And it looks like a Medicare nursing home, so bottom of the barrel. Staff is friendly enough to her when they come in the room. I did ask if she gets help with feeding. She doesn't.

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So I’m still a little lost.. who did you ask if she gets help feeding? The staff or her sister? So what does sister intend to do to rectify this feeding situation? Unfortunately you don’t have much power in this, except to visit often and keep reporting your findings to the sister. And when you’re there make sure the staff knows she needs help. If the aid is dismissive insist on talking to the RN.

Bu the way if you’re referring to “Medicaid” nursing homes they are not all “bottom of the barrel”. My mom was in an wonderful NH that accepted both Medicaid and private pay. No one other than the billing office knew how their residents paid. Good care can be received anywhere as long as the family and/or friends are involved and demand it.

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My daughter was a Candy Striper at a local nursing home. It was her job to feed the residents that could not get to the dining room and feed themselves.

It is a public facility and well run, but there simply are not enough staff to feed all those who need feeding. Volunteers take up the slack.

Many of the Candy Stripers go into a career in medicine and their volunteer hours help with admission into the programs.

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Those programs are wonderful for young people looking into a career of healthcare, plus makes such a difference for the elderly residents!!

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Did they bring her dinner to her room, or to the dinner table? They may have assumed you were there, knowing her condition, and were planning to feed her. If a resident needs to be fed, they avoid letting them stay in their room for meals because it mean an aid has to be in there with them, when it’s much more efficient to bring them to the dining room where they could possible deal with 2 people at once. The statement about her swallowing may have been just a warning to watch for issues, although if she had been actually diagnosed with a swallowing issue by the Speech Therapist, she would be on a ground diet.
You may want to ask her family if she’s supposed to have help eating. At Moms NH there was a table for people who were self sufficient, one for people to could do it but needed encouragement, and a few tables for people who had to be sat with and fed. Their level of assistance was determined by the RN and the Speech Therapist. So if you have info from the family on what her level of assistance at meals is supposed to be, it would be good for you to know for future visits. Also you could share with them that she ate really well for you! That’s always a nice thing to hear.
So you asked if this is standard practice...it would be helpful to have a little more backstory and if they were assuming you would feed her, but no, leaving a person to eat when physically impossible is not standard practice.

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I would contact family or M..P.O.A. an let them know what happened. If this is going on alot or neglect contact St Nursing Board or Ombudsmen. Or look up how to file complaint on a nursing home in your state. An encourage family or friends to visit OFTEN. Goodluck an god bless

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Her POA needs to request help with meals and then someone needs to monitor that is happening.

I would contact the state and file complaints, I have found that is the only way to get anything fixed. Fear of fines or losing their licensing is the only language that they understand, especially a place that would do what you witnessed. Your friend is being starved to death, how cruel is it that she has food in front of her and can't get it in her mouth. We don't even treat prisoners like that.

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I agree this is concerning. Couple of thoughts. Would they usually bring her to the dining room, but brought the meal to her room because she had a visitor who could help her eat? Do you have any idea why she is so stiff? People with advanced Parkinson's can get very stiff and can also have swallowing difficulties. However, it sounds as though your friend ate her meal just fine while you were there and is not on any modified diet. If the NH thinks she's having trouble swallowing, they should get a swallowing evaluation from a specialist (speech therapist) and, if necessary, put her on a texture modified diet. Being so stiff she can't feed herself must be very frustrating for your friend, but it sounds as though she has a good appetite and will benefit from being assisted during eating. She'll be able to take in more calories if assisted, and they will also be able to watch her closely if they think she is havng swallowing problems. If she is losing weight and is "skin and bones," she might also benefit from an evaluation by a nutritionist and be given a high calorie diet, with supplements such as nutritional drinks. Do you know if someone in your friend's family has medical POA? If so, they should ask for a care conference to discuss the situation in a non-confrontational way.

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Really great tips & thoughts:)

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Where I live everyone in nursing homes is brought to the dining room for all their meals; IMO what is given up in privacy and free will is made up for by the fact that there is much closer supervision and many eyes to watch for problems.
It is hard to say from one visit what the truth is with your friend, she may just have been having an exceptional day. Your description of what sounds like contractures in her legs and arms are a red flag to me as they are a sign of neglect - does she ever leave her bed and room? The unfortunate thing is that you have no real idea of her status and how aware and proactive her family/POA is, if you have a good relationship with them then you might tip toe through the minefield and ask in a "curious not furious", non threatening way.

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I visited a friend in a nursing home yesterday and they brought her dinner, and left it. Is this standard practice?

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