Long-Term Care Survey Alert

The bad news: Not only is dehydration potentially life-threatening, but surveyors view it as a sentinel event, which means your facility can be in big trouble if it occurs even once. The better news: You can prevent most cases by simply ensuring residents drink enough fluid.

Easy enough said, but nursing home staff in the real world know they have to constantly battle several obstacles to keeping residents well hydrated.

For starters, older people dont feel thirsty due to age-related physiological changes, so you have to continually remind and entice them to drink, says Janet Mentes, a geriatric nurse practitioner and assistant professor at the University of California School of Nursing at Los Angeles. (See "Are Your Residents Drinking Enough Fluids?" for suggestions to encourage fluid intake.)

In addition, some residents tend to choke on fluids but refuse to drink thickened fluids, which are known for being unpalatable. Yet there are tastier, everyday alternatives that serve the same purpose as thickened liquids for example, fruit smoothies or frozen popsicles made from juice. "Some facilities use honey to thicken liquids," Mentes adds. "The idea is to keep fluids and drinking as normal as possible."

Residents with swallowing difficulties (dysphagia) also require monitoring when they drink, which can be difficult to provide during shifts when staffing is tight. One solution: Host an early afternoon tea time and an evening "happy hour" daily where residents with dysphagia can drink fluids in a social setting while staff can keep an unobtrusive eye on them.

Disabled residents may have difficulty drinking on their own and end up dehydrated as a result. To address this problem, the Illinois Council on Long-Term Care suggests asking the occupational therapist to recommend self-help devices, such as long flexible straws and spouted or two-handled cups. Residents who have increased stiffness may be able to drink more independently by using a cup with a cutout on the upper rim for the nose.

Then there are the residents who purposefully limit fluids in an effort to control their urinary incontinence. "You have to identify residents who are doing that and work with them," Mentes suggests.

Staff might contract with the resident to drink fluids at certain times of the day, perhaps limiting intake near bedtime. "Then work on their incontinence, including a toileting program and in some cases, a comprehensive assessment to identify what might address their specific cause of incontinence," Mentes advises. (See the August Long-Term Care Survey Alert for a practical and in-depth focus on managing incontinence.)

Tips: Direct CNAs to give residents 8 ounces of fluid with morning care, suggests Annette Kobriger, a long-term care nutritional consultant with Kobriger Presents in Chilton, WI. "At that time of the morning, residents are usually hungry and thirsty." The Illinois Council also suggests offering residents a full glass of fluid with medications. The council says studies have shown that residents tend to drink the entire amount of fluid offered. Also offer residents very small amounts (2-4 ounces) of fluid at each care encounter, which will add up, suggests Cil Bullard with Monette LTC Services in Smithfield, VA.

Getting the dietary team in the picture can help prevent dehydration by increasing foods high in water content. "Fruit actually provides almost as much water content as juices and pudding is a good source of fluid," says Kobriger. "Gelatins and creamed dishes are also good options. And residents like ice cream, which can be offered as a snack.

"Hot cereals are also very high in water because you rehydrate them and usually add more fluid, such as milk."

Pureed foods contain a lot of water but residents on such diets often refuse to eat what they view as baby food. And if they dont eat well, theyre missing out on a major source of daily fluid intake.

Meadowlark Hills in Manhatten, KS, attempts to pique the appetites of residents who require pureed diets by serving entrees such as salmon mousse and well-seasoned beef mold served in slices.

Tips: Serve pureed fruits with a little cinnamon or other spices in carved-out apples or fruit-shaped dishes. Prepare delicious pureed cheese or vegetable soups. Pureed soup recipes are available online at www.recipesource.com/soups/soups/in dex46.html.