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Individualized Feeding Assistance Care for Nursing Home Residents: Staffing Requirements to Implement Two Interventions

¹ University of California, Los Angeles, School of Medicine, Department of Geriatrics, Borun Center for Gerontological Research.
² Jewish Home for the Aging, Reseda, California.
³ Veterans Administration Greater Los Angeles Healthcare System, and Sepulveda Geriatric Research, Education, and Clinical Center, Sepulveda, California.

Address correspondence to Sandra F. Simmons, PhD, Jewish Home for the Aging/UCLA, Borun Center for Gerontological Research, 7150 Tampa Ave., Reseda, CA 91335. E-mail: ssimmons{at}ucla.edu

Background. Recommendations have been made to increase the number of nursing home (NH) staff available to provide feeding assistance during meals and to individualize care for residents. However, there are few data reflecting the number of residents responsive to feeding assistance during meals and what alternative interventions might be appropriate for other residents. The purpose of this study was to evaluate the effects and staffing requirements of two individualized feeding assistance interventions to improve oral food and fluid intake in NH residents.

Methods. Skilled nursing participants (n = 134) in 3 NHs received a 2-day trial of one-on-one feeding assistance during 6 meals. 68 participants who did not increase their oral intake in response to feeding assistance during meals received a 2-day intervention trial during which snacks were offered between meals 3 times daily. As part of both interventions, research staff provided adequate feeding assistance that enhanced the resident's self-feeding ability, social stimulation throughout the meal or snack period, and availability of choices for foods and fluids.

Results. 46% significantly increased their oral intake in response to one-on-one mealtime feeding assistance, and the staff time required to implement this intervention was 35 (± 8) minutes/meal per resident compared with usual NH care, which averaged 6 (± 9) minutes. 44% of the participants significantly increased their oral intake in response to the between-meal snack intervention, which required 12 (± 6) minutes of staff time per snack/resident compared with usual NH care (1 ± 4 minutes).

Conclusions. Most participants (90%) significantly increased their daily oral food and fluid intake in response to one of two individualized interventions. The staff time necessary to implement each intervention was significantly greater than the staff time currently being spent on feeding assistance care delivery. Suggestions are made to increase the efficiency of staff time when delivering feeding assistance.