MDS Alert

Question: One of our residents has dysphagia and receives swallowing therapy. He has suffered from aspiration pneumonia in the past, as well as urinary tract infections (UTIs). His doctor prescribed nectar-thickened liquids and wants to boost his hydration. The resident requests caffeinated coffee, but I know caffeine can actually dehydrate people. Do we still provide coffee for him?

Louisiana Subscriber

Answer: Unless the physician has specifically said that the resident shouldn’t have coffee, you should try to meet the resident’s wishes.

In F692, Appendix PP of the State Operations Manual instructs surveyors to evaluate residents’ nutritional/ hydration status. The guidance specifically tells surveyors to see whether residents’ preferences are being met: “The nutritional assessment includes an estimate of calorie, nutrient and fluid needs, and whether intake is adequate to meet those needs. It also includes information such as the route (oral, enteral or parenteral) of intake, any special food formulation, meal and snack patterns (including the time of supplement or medication consumption in relation to the meals), dislikes, and preferences (including ethnic foods and form of foods such as finger foods); meal/snack patterns, and preferred portion sizes.”

If you’re worried about hydration status, there are other ways to help a resident stay hydrated. In various Ftags, surveyors are instructed to make sure residents have access to water or other fluids between meals and to check whether other hydration-boosting alternatives, like popsicles, are available. Surveyors will look to cite facilities for F807 if they observe residents’ hydration needs or preferences going unmet by the facility.

“This regulation requires facilities to ensure that residents are provided with and receive drinks that are consistent with their needs and preferences and are provided in sufficient quantity to maintain hydration levels,” explains Linda Elizaitis, RN, RAC-CT, BS, president and founder of CMS Compliance Group in Melville, New York.