This week’s Ftag of the Week on the CMSCG Blog is F807 Drinks Available to Meet Needs/Preferences/Hydration, which is part of the Food and Nutrition Services regulatory group. 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. The Interpretive Guidance (IG) states that residents who do not receive sufficient hydration are more likely to end up with potentially harmful health conditions, including skin infections/ulcers, pneumonia or UTIs. Residents who are not properly hydrated many also experience disorientation or confusion.
Facilities that do not have sound systems in place to ensure residents are provided with fluids – whether water or another beverage or liquids in other forms such as ice cream or popsicles – are very vulnerable to being cited under F807. The reason for this is two-fold. First, surveyors can easily observe residents who, for instance, have dry, chapped lips or who have water pitchers in their rooms well out of reach. Second, resident interviews are providing more and more “ammo” for surveyors under the LTCSP. Looking at actual citations under F807 should provide clarity to our readers:
- On interview, a resident’s family member told a
surveyor that residents have not been receiving water between meals for months.
A staff member confirmed this during interview and told the surveyor that
residents were only getting water during and between meals because the survey
team was onsite . The facility was not able to provide any documentation that
water had been passed between meals. (S/S: F) - A resident told a surveyor that he does not
receive fresh ice water unless he requests it. Surveyors observed over the next
3 days that residents did not have any hydrating drinks in their rooms or at
their bedsides. Follow up with residents during survey indicated that they are
not served water, and if they request it, that it is provided in the small cups
used for med administration (S/S: E) - During a Resident Council Meeting, half of the
residents present stated that they preferred caffeinated coffee, but the
facility only provides decaf, which is not in accordance with their
preferences. Surveyors conducted an observation of the kitchen and found that
the majority of coffee available was decaf and the regular coffee had only been
purchased after it was noted that residents complained (S/S: E) - During meal observation, it was noted that
diabetic residents who requested diet soda were provided with regular soda by a
CNA since they were out of diet soda. Other diet beverage choices were
available. Additionally, during a resident interview, a resident told a
surveyor that staff did not bring fresh water unless it was requested, and that
her water mug was not even in her room. The resident stated that she was
concerned because a few years prior, she was so dehydrated at the facility that
she had kidney failure and was hospitalized (S/S: E).
As you can see from the above scenarios, there are many instances that can result in a deficient practice being identified. Another commonly cited area not mentioned previously is based on residents telling surveyors that fresh water is not provided daily, and if it is, it is done in the middle of the night and then not refreshed against. Providers have a responsibility to ensure that residents are provided with adequate fluids and in accordance with their care plan and needs. Don’t forget – just like call bells, water pitchers need to be accessible to residents in their rooms. There is no excuse for not ensuring that residents who can assist with their own hydration needs have the ability to do so and have access to fresh water.
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