Missouri Nursing Home Dietary Regulations

The state of Missouri has 495 skilled-nursing and 35 intermediate-care nursing homes providing 24-hour health care to senior citizens. To be licensed, these facilities must meet standards set by the Missouri Department of Health and Senior Services (DHSS) in the areas of fire and building safety, administration and personnel, patient care and dietary needs. In the dietary area alone, 23 specific regulations govern meals--the majority of them related to scheduling, food quality and special diets.

Meals

• The DHSS requires that each facility provide three substantial meals a day, at least two of them hot. In addition, snacks must be available between meals for patients requiring them. Meals must be spaced about four to five hours apart. The dining facility must allow at least 30 minutes for each meal and allow patients who are slow in eating to take as much time as they need to finish their meals.

Food Quality

• Food must be nutritious, selected according to a doctor's recommendations and meet nutritional guidelines set by the National Research Council. It must be of the proper flavor, smell, texture, temperature and nutritional value considered standard for that food. The facility should accommodate residents' individual needs regarding food texture or temperature, and if residents refuse a particular food or meal, they should be offered an equally nutritious substitute.

Special Diets

• A registered nurse or certified dietitian must regularly review each patient's nutritional status and eating behaviors and keep the doctor informed of any problems. Sometimes, a doctor may prescribe a particular diet or eating plan for a patient. In this case, the facility must develop an appropriate menu and have it approved in writing by a doctor, registered nurse or dietitian.

Inspections

• To ensure that a nursing home follows dietary regulations, the DHSS conducts an unannounced inspection of a nursing home twice a year. In addition to physically inspecting the facility and observing the nursing home's operations, the DHSS interviews staff, residents and their families to determine if the facility is meeting regulations. If a facility isn't following regulations, it will be cited and required to submit a plan for how and when the violations will be corrected.