What's the matter with allowing feeding assistants in nursing homes?

1. Feeding assistants will not have the training they need to be able to provide critical help to residents with high levels of frailty. By allowing feeding assistants with minimal training and supervision to feed frail residents, the federal Department of Health and Human Services (DHHS) is turning its back on years of research and its own longstanding policy indicating that nursing home resident safety depends on skilled care. Residents who are unable to feed themselves are among the most frail in nursing homes. They do not need help simply with raising a fork to their mouth; many have significant issues related to ability to swallow, “packing” food in their cheeks, and other problems. These residents need and deserve to be helped by someone with the knowledge and ability to make sure that they are fed safely, and that any problems are quickly identified and brought to the attention of a professional caregiver.

2. Mealtimes are just not about feeding a resident . They often present the only opportunity trained staff gets to spend one-on-one time with residents and because of prior interactions with the resident, trained staff can spot differences in behavior or appetite that may be indicative of a more serious problem.

3. Planned safeguards to prevent residents with “medically complicated feeding problems” from being fed by feeding assistants are inadequate. A federal nursing home study reports that more than half of all nursing homes have deficiencies related to resident assessments. If nursing homes cannot be relied on to provide accurate assessments, how will residents with complicated feeding problems be protected?

4. Regulations regarding supervision of feeding assistants are not sufficiently clear to protect residents . Feeding assistants are permitted to feed residents in their room and depending on the interpretation of the federal law, a supervisor does not necessarily need to be in the same unit, or even on the same floor, when feeding is being administered. What will happen if a resident begins to choke? These poorly trained workers will not know what to do and there may not be anyone to help nearby.

5. Using feeding assistants is dehumanizing . Feeding assistants are “task-oriented” workers, focused on the task to be done rather than the resident as a person. Nursing home residents deserve - and need – to be cared for; they are not merely the subjects upon which tasks are performed. It is critical for both their emotional and physical well-being that they be cared for by people who are fully involved in providing care, not merely coming in to perform a task.

6. The introduction of feeding assistants clashes with the national movement towards resident centered care and “culture change.” “Culture change” is the term used to describe the growing movement in nursing home care which focuses on change the way care is delivered by making it more resident centered and giving direct care workers a more meaningful role in the residents' lives and the “culture” of the nursing home. According to the Pioneer Network, a leader in the culture change movement, “Providers that have made substantial progress in culture change have clients (be they elders or individuals living with disabilities) who truly direct their own care and make their own choices about how they spend their time. The workers in these organizations are highly involved in decisions that are relevant to their jobs and the people they care for.”

Culture change, indeed any movement towards resident centered (rather than rote, task centered) care relies on the continued movement toward giving direct care workers increased responsibility, allowing residents to establish “consistent care-giving relationships with their support staff,” and fostering a work environment imbued with greater – not lesser – professionalism and ties to the nursing home community.