Long-Term Care Survey Alert

Ready to do some math? If you really want to get inside the mind of a surveyor, consider studying up on the formula surveyors use to make sure you’re meeting residents’ nutritional needs.

If surveyors have concerns with how your facility is monitoring resident’s food and fluid intake, they may use their own “point system” to calculate meal intake. Then they will compare their calculations to what the staff has documented in the resident’s record and ask if the findings reflect the resident’s usual intake. And you can bet any major discrepancies will lend weight to an F tag.

The Centers for Medicare & Medicaid Services’ dining and food service investigative survey protocol spells out the formula for how surveyors are to assess the percentage of a meal eaten by a resident. Here’s how it works.

Each food item served except for water, coffee, tea or condiments counts as one point. Say the resident’s breakfast includes juice, cereal, milk, bread and butter and coffee. That tallies to four points, because coffee scores a zero.

If the resident consumes all or three-fourths of a food item, that counts as one point. Half of an eaten item earns half a point, and one-fourth of a food item or less gets no points.

To determine the percentage of food eaten, the surveyor tallies the points consumed x 100 and divides by the number of points for the meal (in the above example, four points for breakfast). That gives the percentage of meal consumed.

In calculating points for fluids, surveyors use 30 cc measurements per ounce. Thus, an 8-ounce milk carton is 240 cc and a 4-ounce juice cup (the usual size) is 120 cc.

So, using the above example, if the resident drinks only 30 cc of a usual prepackaged 120-cc orange juice container, the CNA would tally 0 points.

Say a resident drank 90 cc of a 4-ounce juice container and 120 cc of an 8-ounce milk and ate half his cereal and a half slice of evenly buttered toast.

The resident consumed 62.5 percent of the breakfast meal, based on the formula..

Some facilities adopt the formula to assess dietary intake, but it takes training and ongoing monitoring to ensure accuracy, experts caution.

If you are going to use the method, take some tips from a study on assessing dietary intake in nursing homes published in a recent issue of the Journal of the American Dietetic Association (www.eatright.org/journal/2002/j0602.html). Researchers found that CNAs tended to over focus on assessing the main plate and omit beverage consumption. They also tended to pick up opaque beverage containers to “feel” how much the resident drank, resulting in inaccurate estimates.