Assisted living and skilled nursing facilities seek to provide balanced, nutritional meals for their residents, but when your parent isn't eating enough, it could signal an underlying medical problem, depression or another issue affecting their well-being.

The staff at a senior living community should be regularly monitoring your parent's weight and eating habits. If your parent is not showing up for meals in the dining room or losing weight, the staff should be making changes to get them the nutrients they need daily.

Tonya Maldonado, a licensed nursing facility administrator at Gracy Woods Nursing Center in Austin, Texas, shares tips for recognizing if a loved one isn't getting the nutrition they need, possible causes, and ways to address and prevent weight loss.

Signs a Resident Isn't Eating

  • Weight loss
  • Complaints of an irritated mouth
  • Pocketing food on side of mouth
  • Chewing too much
  • Lack of interest in food or mealtimes
  • Difficulty seeing food or using utensils
  • Coughing or eyes tearing while eating or drinking

Causes of Eating Problems Among Seniors

  • Sometimes the eating problem is related to illness, an existing medical condition, Alzheimer's or a change in medications. The staff should be able to recognize if eating habits are related to these causes.
  • As we age, our senses dull. Reductions in sight and smell can make it difficult for seniors to find food appetizing or even see it clearly enough to eat. Brightly colored foods and plates are said to be helpful for increasing food consumption in dementia patients.
  • The food being served doesn't match your parent's preferences, such as being too spicy or not spicy enough, Maldonado says. The staff should ask a resident's preferences from the beginning to make sure the food is enjoyable. (Keep in mind that preferences can change!)
  • Yet another reason for a reduction in eating may be that the elder is simply overwhelmed by a plate of food and can't decide what to eat. In that case, they may need to be served small portions of each part of a meal one at a time.
  • Dysphagia is another culprit for individuals with advancing Alzheimer's or other forms of dementia. Choking can be frightening for someone with cognitive issues, so they may avoid eating and drinking or cheek their food.
  • Excessive chewing can be caused when eating and swallowing processes are compromised due to neurological damage. Sometimes the brain and muscles in the throat fail to coordinate and work effectively, especially in dementia patients.
  • Loose or ill-fitting dentures and other dental problems can cause a great deal of irritation and pain, which can affect a senior's ability and willingness to chew food.
  • Digestive issues like constipation can cause patients to feel bloated or nauseous, thereby reducing their appetite.
  • Depression is a common culprit in cases where seniors begin to lose interest in routine activities and things they once enjoyed, like meals.
  • For residents with dementia or Alzheimer's there may be too much noise or movement in the dining room, which distracts them from their meal. One solution is to seat the elder in a less crowded area or turn them in the direction of a window or a wall to limit distractions, Maldonado says.

    Other senior communities help to reduce mealtime stress and anxiety for residents with Alzheimer's or dementia by seating them at the same table for every meal, with the same eating companions. When residents know where they will sit and who will be eating with them, mealtime is predictable and routine, which is very important for people with cognitive disorders. Some facilities have special seating in the dining room for residents who need assistance and encouragement during meals.

Medicare and Medicare Regulations for Tracking Nutrition

If the assisted living or skilled nursing facility accepts Medicare or Medicaid, it is required to weigh patients monthly and respond to a certain percentage of weight loss within a specified time frame, set by the state. For example, that could be a 5 percent weight loss within 30 days, 7.5 percent within three months and 10 percent within six months. If the elder loses that amount of weight, the facility is required by Medicare or Medicaid to report the problem to the family and make a plan of action to resolve the eating issues.

If the facility does not accept Medicare or Medicaid, you need to ask how the facility monitors what residents are eating and any weight loss issues.


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What to Do if a Resident Isn't Eating

If the nursing staff sees a resident not eating for a couple of days, the facility should already be taking steps to boost their weight by adjusting what they are being served or giving them a different meal options, says Shona Alexander, a nurse practitioner and director of clinical and home care services at Park Springs, a senior living community in Stone Mountain, Georgia. Another option will be to add a supplement, such as a shake, at mealtime or as a snack.

Family members of the resident should be informed as soon as a weight loss problem is noticed, Alexander says. If weight loss has been identified, she says a member of the nursing team is likely to document daily the percentage of food that the resident eats, and the resident will be weighed weekly.

If the resident is forgetting to come down to the dining room, one change that could be implemented is to have a nurse or staff member take them to eat. Residents eating less than 50 percent of any meal typically will be offered another option or receive alternatives such as supplemental shakes in between meals, snacks or having certain components, such as the meat, pureed.

Sometimes a little bit of sugar can be added to the food, to pique the elder's interest in eating.

"One of the last thing your body loses is the taste of sugar," Maldonado says. "That will get it to where they have that taste again and will eat more of it, with a little bit of sweetener to it."

If those steps don't work, the resident should see a dietician, doctor or therapist. For example, if an elder has had a stroke and lost use of their dominant hand, an occupational therapist may provide a special utensil with a larger handle, if the elder is having a problem moving the food from the plate to their mouth. If they are having difficulty swallowing due to advancing dementia, a speech-language pathologist can help devise solutions that promote safe and healthy eating.

"Sometimes it gets to the point where that person may need a feeding tube if they're really not eating," Alexander says.

What Caregivers Can Do

If you are researching assisted living or skilled nursing facilities or if your parent is already a resident, ask them how they monitor and address eating problems.

Facilities may have a registered dietician and/or certified dietary manager on staff to make recommendations and create individualized eating plans. Some facilities will have a weight loss committee made of nurses, dieticians and others that recommend ways to increase or maintain an individual's weight. Others will hold a patient care conference with staff and family members to discuss options to increase weight.

If you have noticed your family member is not eating, tell the nursing supervisor or a dietician on site. Communication between family members and the nursing staff is imperative and welcomed, Maldonado says.

"Family members and caregivers know their loved ones. We're trying to learn their habits, what they like and what they don't like," Maldonado says. "Families can often pick up on a problem like this a lot sooner than we can."