Maintaining adequate nutritional/hydration status and prevention of weight loss in LTC residents can be challenging. According to AMDA data, 50-60% of LTC residents experience weight changes and 12% are chronically undernourished (based on BMI). Learn more about the requirements of F692, key resident risk factors that should be monitored and strategies for effective facility processes in this week’s blog…

Federal regulation F692 includes these 3 requirements:

Based on a resident’s comprehensive assessment, the facility must ensure that a resident—

      • Maintains acceptable parameters of nutritional status, such as usual body weight or desirable body weight range and electrolyte balance, unless the resident’s clinical condition demonstrates that this is not possible or resident preferences indicate otherwise;
      • Is offered sufficient fluid intake to maintain proper hydration and health;
      • Is offered a therapeutic diet when there is a nutritional problem and the health care provider orders a therapeutic diet. Source: Appendix-PP-State-Operations-Manual

Risk Factors

      • There are several diagnoses and conditions that can increase the risk for loss of appetite, inadequate intake and weight loss. Examples include cognitive issues, cancer Dx, endocrine/metabolic Dx, Neurological Dx, medications, therapeutic/mechanically altered diet, oral/dental issues, GI issues, loss/decline of taste/smell, acute illness, mood/behavior issues, etc.
      • Risks associated with inadequate nutritional/hydration status and significant weight loss include: skin breakdown, lack of wound healing, cognitive decline, functional decline, increase in susceptibility to infections, delayed recovery from illness. Source: AMDA 2010 data

Tips for Effective Processes

      • Nutritional assessments should include risk factors that may impact nutritional/hydration status and weight loss. Food Preferences should be routinely reviewed and updated (especially after a change in diet orders or loss of weight).
      • Nutritional Care Plan development and revisions should include an IDT approach and interventions should be individualized to meet resident’s needs based on the comprehensive assessment.
      • The Weighing of Residents Policy should include guidelines for obtaining accurate weights, routine monitoring of weights (how often and responsible staff), and calibration of scales (per manufacturer’s recommendations).

CMS has provided facilities with a Critical Element Pathway for Nutrition (CMS-20075) that can be used as a teaching and QA tool. It guides you step-by-step through the Surveyor’s process in determining if compliance is met. CMS Downloads-LTC Survey Pathways

Additional Education

To learn more about ‘Nutrition, Hydration, and Weight Loss Standards of Care’ register for the upcoming Proactive Medical Review webinar:

Contact Proactive for care plan review assistance or to schedule  a mock survey and don’t miss the November 16-17 2021 webinar Nutrition, Hydration and Weight Loss


Angie Hamer, RN, RAC-CT Clinical Consultant CPC Clinical Consultant

Learn more about the rest of the Proactive team.