Food and Nutrition Services F-808: Therapeutic Diets

F-Tag #808 Blog

Food and Nutrition Services F-808: Therapeutic Diets

Appetizing meals in skilled nursing? The answer is, “Yes!”

When my grandmother was a resident in the “nursing home” when I was a child, I swore I would promote healthy, appetizing food when I grew up no matter what kind of diet residents were on. Although the food wasn’t terrible, I just saw that it was very different from the food I ate at home. As an administrator and dietitian today, I know that my grandmother received mechanical soft food that was prepared with little attention to presentation and eye-appeal. Although residents in skilled nursing continue to receive mechanical soft, dysphagia and pureed diets, I strongly believe they can still have that “wow” factor. Who wouldn’t want a beautiful salmon pate instead of a #16 scoop of pureed fish?

Although our residents deserve the best quality food presented beautifully, there are still things we need to consider.

Today, as part of our reviews of F-Tags, we are taking a look at F-808, which addresses therapeutic diets that must be prescribed by physicians in the skilled nursing community setting. This tag is also part of the Food and Nutrition Services regulatory group, and is intended to ensure that residents receive and consume foods that are in the appropriate form and/or have the appropriate nutrient content to support the resident’s needs.

If allowed by the specific State’s Law, the attending physician may delegate prescriptive authority of diets to a registered or licensed dietitian, but would remain responsible for the resident’s care and must supervise the dietitian. Per the CMS Interpretive Guidelines, the physician is still responsible for continued oversight and still has the ability to modify a diet order if necessary.

A therapeutic diet is a special diet ordered by a physician/delegate with one or more of the following purposes:

  • The diet is part of a disease or clinical condition’s treatment
  • The diet is meant to eliminate/decrease specific nutrients in a resident’s diet
  • The diet is meant to increase levels of specific nutrients in a resident’s diet

A mechanically altered diet means that the diet texture has been specifically altered according to the physician’s or delegated dietitian’s order. In other words, we are serving resident food that has been chopped up or blenderized for their safety due to swallowing difficulties.

It is very important to monitor that the food served to the resident is according to their diet order. During annual inspection, the surveyor will observe all residents eating, but will put extra attention to those in need of a modified diet related to their medical diagnosis, such as dysphagia. If a resident receives a regular texture entrée when puree is on the meal ticket, the surveyor will most likely cite the community, especially if the wrong consistency of food is consumed by the resident. Additionally, if a resident on a fluid restriction is served unlimited amounts of fluids, the surveyor will most likely cite this incident as well. Needless to say, it is crucial for the dining team to pay close attention to the meal ticket and for the nursing team to double check for accuracy at the dining table. The surveyors will look at other areas as well, such as procedures for assisting residents with eating, so everyone plays a big role in ensuring that the resident is properly cared for.
Bottom line, safety is always the number one priority, but we want our residents to want to eat, to have an appetite for what is being served.
If you need assistance with taking your mechanical soft diet or carbohydrate controlled diet to the next level, call us at Culinary Coach!

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