Long-Term Care Survey Alert

Initially released survey guidance for tube feedings (F322), which CMS had at press time temporarily withdrawn, says that "to assure that the resident being fed by a feeding tube maintains the highest degree of quality of life possible, it is important to minimize possible social isolation or negative psychosocial impact to the degree possible (e.g., continuing to engage in appropriate activities, socializing in the dining room)." (For more information on the guidance, see page 83.)

Overcome this potential obstacle: "If a resident receiving continuous tube feedings feels self-conscious of being attached to a feeding pump while out of their room, you can ask for a routine order for 'feeding interruption time,'" says Reta Underwood, an activity expert and president of Consultants for Long Term Care Inc. in La Grange, Ky. "This can be done with a PRN order for a specified time frame, i.e., 'PRN disconnect feed for no more than one hour and 30 minutes to attend out of room activities.'"

At Northern Oaks Living and Rehabilitation Center, "we encourage all residents to get out of their rooms and to attend activities of their choice," says Barbara Lohman, MSW, social services director for the facility in Abilene, Texas. "If a resident who is tube fed wants to attend an activity, the activity director makes sure that they get to that activity," she tells Eli. "Some of our residents like to pass the time 'people watching' in our lobby."

Safety tip: Miltenberger points out that if someone isn't supposed to have anything by mouth, taking the person to the dining room to socialize could put them at risk "for taking food off someone's plate and aspirating. Your care plan and documentation need to show that you've thought about those issues," advises Miltenberger, with Husch Blackwell in Jefferson City, Mo.