April 2004 Food For Thought
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FOOD FOR THOUGHT

Feeding Assistants:
Causing a Mouth Full of Controversy

"�What would you attempt to do if you knew you would not fail?"�
" Dr. Robert Schuller

In September 2003, the Centers for Medicare and Medicaid Services (CMS) created a new rule applying to nursing homes that receive Medicare or Medicaid funding. The rule allows for trained assistants to help residents with eating and drinking. The rule officially went into effect on October 27, 2003, and it's sparked some heated debate" to say the least.

Under the general guidelines of the rule, nursing homes can hire feeding assistants who have passed a minimum eight-hour, state-approved training course. These assistants are required to work under the supervision of an RN or LPN. Also, the assistants can only help residents who do not have complicated feeding needs" the facility's charge nurse decides as to which residents are eligible to be helped by the. The rule also states that staff should review each resident's last assessment and plan of care to help determine his or her eligibility.

The Sweet Taste of Success
Some large agencies" including the American Health Care Association (AHCA) and the American Association of Homes and Services for the Aging (AAHSA) are proponents of the rule. Entities in favor of the implementation of this rule say it will enable nursing facilities to allocate resources more effectively to meet the needs of their residents. They state that the ability to free up staff time is a tremendous benefit the rule provides. It will allow for licensed personnel to attend to those people who have more complex eating problems, while the feeding assistants can tend to residents who do not call for such skilled care. Even where facilities are highly staffed, the rule still affords an opportunity for more one-on-one attention. It also may expose some of these part-time feeding assistants to long-term care as a profession, which could in turn help alleviate the staffing problems many facilities face.

A Hint of Bitter
While some groups have come out in support of this new rule, it's leaving many others with a bad taste in their mouth. Some prominent consumer-oriented groups, such as AARP and the Alzheimer's Association have come out against it.

Quite simply, some feel this rule will cause harm to nursing home residents. Many critics feel the rule is just a guise to avoid the nation's nursing home staffing crisis and related problems, such as resident malnutrition and dehydration. Other concerns skeptics include:

"¢ The eight-hour training course for feeding assistants might be too short, and thus might not properly equip workers with the skills they need to do the job right.
"¢ The course need not be given by a licensed health care professional.

"¢ Feeding assistants need not pass a written competency test after taking the course.
"¢ Assistants might take actions that are beyond their scope of training or be unable to handle emergency situations.

The Next Course of Action
Now that CMS has adopted this new regulation, its implementation rests in the hands of the states. Some states say they are ready to go and simply need to plug in some details to get their programs up and running. Some must go to their respective state legislatures for approval before proceeding. Other states like North Dakota and Wisconsin have allowed paid feeding assistants to supplement nursing staff for a number of years. Florida and Illinois have already passed laws allowing for such workers, but have yet to implement them. In any case, it's apparent that the future of feeding assistants will remain in debate.