A Medico-Legal Evaluation of Dehydration and Malnutrition Among Nursing Home Residents
Julie A. Braun
Law Offices of Julie A. Braun
Emory University - Nell Hodgson Woodruff School of Nursing
Elder Law Journal, Vol. 8, Pp. 239-296, 2000
This article presents a medico-legal evaluation of common nutrition-related problems presented in nursing homes. Among the larger problems are weight loss and concomitant protein energy undernutrition, complications from tube feeding, dehydration, malnutrition, swallowing disorders, and choking. The article begins by considering the nutritional assessment and care planning process. This discussion is accompanied by a review of nutritional services department staff and their responsibilities. The article then shifts its attention to common liability fact patterns involving weight loss, tube feeding, dehydration, malnutrition, swallowing disorders, and choking. In each instance, the authors offer definitions, prevalence estimates, and risk factors associated with the clinical condition along with relevant federal law and regulation on the subject, punctuated with case illustrations. Next, the article highlights the standard of care used in nutrition-related cases through federal statutes and companion regulations, interpretive guidance to federal regulations, state statutes and regulations, nursing home industry standards of practice, facility policy and procedure, voluntary accreditation standards, and standards promulgated by professional organizations. The article concludes with the medico-legal aspects of nursing home records. These records include hospital discharge summaries; nursing home admission notes and physical examination forms; physician orders and progress notes; daily nursing notes; nutritional reviews, meal forms, and dietician/ nutritional consultant forms; medication records; subspecialty records, intake and output (I & O) records; weight records, and dental/oral health records.
Date posted: June 14, 2001