Legal evaluation of malnutrition claims

Nursing home residents should not suffer unnecessarily from malnutrition which can be prevented with proper care.

Potential signs and symptoms of malnutrition are:

• Pale skin
• Dull eyes
• Swollen lips
• Swollen gums
• Swollen and/or dry tongue
• Poor skin turgor (when you pinch the skin, it stays indented and doesn't go back to normal quickly)
• Swelling in lower legs
• Weight loss; and
• Muscle wasting

Risk factors for malnutrition are:

• Poor teeth or poor oral hygiene
• Depression or dementia
• Difficulty swallowing
• Slow eating pace resulting in food getting cold or in the staff removing the tray before the resident has finished eating
• Cancer
• Stroke resulting in paralysis that renders the resident unable to feed themselves

We will evaluate the records to look for evidence that the resident was being provided proper nutrition. The first thing that should be done when a resident is admitted to the nursing home, is a nutrition assessment. An appropriate diet should be ordered, including any supplements such as snacks or ensure, if necessary. Persons at risk for malnutrition should be identified and a proper plan of care to assure that the resident receives sufficient nutrition should be implemented. The care plan should not only be implemented, it must be re-evaluated and changed when necessary based on changed in the residents food intake, weight, or laboratory values that may show evidence of malnutrition. We will assess whether the staff's concerns regarding signs and symptoms of malnutrition are clearly documented, along with consistent efforts to communicate concerns to the dietary department and to the physician.

We will look for documentation that the nursing staff was fulfilling their responsibilities, if warranted, of assisting the resident with meals, documenting the amount of food the resident is eating at each meal and offering food substitutes based on patient preference. We will also look for documentation that the resident's nutritional status was being monitored by checking for:

• Weight gain or weight loss
• Laboratory values - a simple blood test can be done to check the residents nutritional status. If some levels are below normal range, such as the protein or albumin level, it may be an indication of malnutrition.

In some cases, it may not be possible to provide adequate nutrition because the resident may be very sick and have some of the following medical conditions:

• The resident may refuse to eat due to depression or other reasons;
• The resident may have advanced cancer and treatments such as chemotherapy and radiation may cause severe nausea, vomiting, and lack of appetite;
• Advanced kidney disease;
• Alcohol and drug abuse, chronic blood loss, hyperthyroidism; and
• Gastrointestinal surgery

If your loved one refuses to eat or is unable to eat due to a serious medical condition, talk with the physician and determine what alternatives are appropriate, such as supplements or tube feedings.

Malnutrition Resources:

• Evaluating dehydration claims
• Overview
• Prevention tips
• Understaffing issues

Other Nursing Home Abuses:

• Bedsores
• Dehydration
• Elopement
• Falls
• Malnutrition
• Mental Abuse
• Physical Abuse
• Restraints
• Sexual Abuse
• Wandering
• Wrongful Death

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