F807
(Rev. 173, Issued: 11-22-17, Effective: 11-28-17, Implementation: 11-28-17)
§483.60(d) Food and drink
Each resident receives and the facility provides—
§483.60(d)(6) Drinks, including water and other liquids consistent with resident needs and preferences and sufficient to maintain resident hydration.
GUIDANCE §483.60(d)(6)
Proper hydration alone is a critical aspect of nutrition among nursing home residents. Individuals who do not receive adequate fluids are more susceptible to urinary tract infections, pneumonia, decubitus ulcers, skin infections, confusion and disorientation.
Other food items may also include items that become a liquid at room temperature, such as popsicles and ice cream.
If a concern is identified regarding maintaining a resident’s hydration status or about a resident’s fluid restriction, see §483.25(g)(1)-(3), F692, Nutrition/Hydration Status.
PROBES §483.60(d)(6)
- Are drinks and other fluids provided when the resident requests and consistent with the resident’s care plan, preferences and choices?
- Does facility staff provide sufficient drinks that the resident prefers to maintain hydration?
- Are other liquids, such as broth, popsicles, or ice cream, offered to the resident to encourage fluid intake?
- What action does facility staff take to ensure resident hydration is maintained if a resident refuses the fluids offered?
POTENTIAL TAGS FOR FURTHER INVESTIGATION §483.60(d)(6)
During the investigation of F807, the surveyor may have identified concerns with additional requirements related to outcome, process, and/or structure requirements. The surveyor is advised to investigate these related requirements before determining whether non-compliance may be present at these other tags. Examples of some of the related requirements that may be considered when non-compliance has been identified include, but are not limited to, the following:
- §483.10(c), F552, Right to Make Treatment Decisions
- Determine if the facility addressed the resident’s right to refuse treatment, including drinks and thickened fluids.
- §483.20(b), F636, Comprehensive Assessments
- Determine if the resident’s hydration status was comprehensively assessed.
- §483.21(b)(1), F656, Comprehensive Care Plans
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- Determine if a comprehensive care plan was developed to address a resident’s hydration needs and fluid preferences.
- §483.21(b)(2), F657, Comprehensive Care Plan Revision
- Determine if the care plan was periodically reviewed and revised by appropriate staff, in conjunction with the practitioner and with input from the resident or his/her legal representative, to address resident hydration needs and preferences.
- §483.25(g)(1)-(3), F692, Assisted Nutrition and Hydration
- Determine if the facility has managed the resident’s hydration needs.
- §483.35(a), F725, Sufficient Staffing
- Determine if the concerns related to providing residents with sufficient liquids is related to having sufficient nursing assistant staff to meet these needs.
- §483.10(c), F552, Right to Make Treatment Decisions
- Determine if the facility addressed the resident’s right to refuse treatment, including drinks and thickened fluids.
- §483.20(b), F636, Comprehensive Assessments
- Determine if the resident’s hydration status was comprehensively assessed.
- §483.21(b)(1), F656, Comprehensive Care Plans
- Determine if a comprehensive care plan was developed to address a resident’s hydration needs and fluid preferences.
- §483.21(b)(2), F657, Comprehensive Care Plan Revision
- Determine if the care plan was periodically reviewed and revised by appropriate staff, in conjunction with the practitioner and with input from the resident or his/her legal representative, to address resident hydration needs and preferences.
- §483.25(g)(1)-(3), F692, Assisted Nutrition and Hydration
- Determine if the facility has managed the resident’s hydration needs.
- §483.35(a), F725, Sufficient Staffing
- Determine if the concerns related to providing residents with sufficient liquids is related to having sufficient nursing assistant staff to meet these needs.
1 Chidester, J.C., and Spangler, A.A, “Fluid Intake in the Institutionalized Elderly,” Journal of the American Dietetic Association 97 (1991):23-30.
2 Feinsod, F., Levenson, S., Rapp, K., Rapp, M., Beechinor, E., Liebmann, L. (2004). “Dehydration in frail, older residents in long-term care facilities.” Journal of the American Medical Directors Association, 5(2 Suppl), S35-S41.
3 Gasper, P.M. “Water Intake of Nursing Home Resident.” Journal of Gerontologic Nursing. 1999; 25(4):22-29.
