Malnutrition & Dehydration

What is malnutrition and dehydration and what problems do these conditions cause in nursing home patients?

We all require adequate calories, protein, vitamins, minerals and water to maintain good health.  Failure to provide elders and dependent adults with necessary nutrition and hydration will lead to a decline in their overall health and will impede healing of any underlying health condition.  In fact, malnutrition and dehydration can directly cause or contribute to the following serious health conditions commonly experienced by nursing home patients:

  • Skin breakdown (bedsores, pressure ulcers, skin tears);  more >>
  • Urinary tract infections;  more >>
  • Weakness and dizziness which can result in falls;  more >>
  • Low blood sugar; and
  • Kidney failure.

If a patient is denied needed nutrition and hydration for an extended period of time, it will ultimately result in death.

Due to the overall importance of good nutrition and hydration, nursing homes are legally required to assess each patient’s nutritional needs, and implement specific steps to ensure such needs are met.

Who is susceptible to malnourishment and/or dehydration?

Only persons who require 24-hour nursing care are admitted to nursing homes.  Accordingly, these patients often have underlying health conditions which make them especially susceptible to malnourishment and/or dehydration.  Such conditions include the following:

  • Nausea, vomiting or diarrhea;
  • Food and drug interactions which decrease the ability of the body to absorb vitamins and minerals;
  • Depression;
  • Swallowing disorders;
  • Tooth loss, dentures that do not fit properly, mouth sores and mouth pain; and
  • Tremors or muscle weakness which limits the resident’s ability to feed himself/herself.

How can I tell if my loved one is dehydrated?

An easy test used to look for dehydration involves pressing down on the patient’s skin, and observing how the skin responds.  If the skin does not quickly “rebound” (return to its normal position), this may be a sign of dehydration.  In another test, someone slightly pinches the patient’s skin and gently pulls upward.  If the skin “tents” (remains standing upward and does not quickly return to its normal position), this may also be a sign of dehydration.  Ask a nurse to show you how these tests are done.

Long-term care facilities who care for elderly and dependent adults must implement a specific care plan for each patient to ensure that he or she does not become unnecessarily dehydrated.  Each patient should be consistently offered and encouraged water to drink unless a doctor has ordered otherwise.

How can I tell if my loved one is malnourished?

The most obvious sign of malnutrition is weight loss.  California law requires every nursing home to weigh each patient at least once every 30 days.  A loss of five pounds or more in a 30-day period must be promptly reported to the attending physician.  Significant weight loss must also be reported to the patient and/or the patient’s representative.  Other signs of malnutrition include the following:

  • Clothes begin to fit more loosely than usual;
  • Cracks develop around the mouth;
  • Lips and the mouth appear pale;
  • Dentures no longer fit snugly;
  • Hair loss or thinning is observed;
  • Cuts and open wounds seem to heal slowly;
  • Skin begins to break down;
  • Eyes appear “sunken;” and
  • The patient demonstrates confusion that is not associated with an underlying ailment (e.g. dementia, urinary tract infection, etc.).

What steps can be taken to prevent malnutrition and dehydration?

California law requires that each patient in a nursing home must be provided good nutrition and necessary fluids for hydration.  Patients who need help with eating must be assisted.  If necessary, the facility must also provide adaptive equipment to allow the patient to feed themselves.  Nursing homes are also legally required, within reason, to consider the food preferences of each patient.

If a patient appears malnourished or dehydrated, the nursing home must implement all necessary measures to prevent further malnutrition or dehydration and to restore the patient to a healthy nutritional and hydration level. Such measures include the following:

  • The facility must develop an individual care plan with measurable objectives.  The patient’s family should be invited to participate.
  • At the request of the attending physician or the facility, a dietician or nutritionist can perform a nutritional assessment.
  • The nursing staff should accurately measure and record the patient’s food intake.
  • If a patient has difficulty swallowing, the doctor can order a special diet that is easier and safer for the patient to swallow.  Special diet supplements can also be ordered.
  • As a last resort, and after consultation with the resident and his/her family, the doctor can order a feeding tube.

How can I tell whether my loved one’s malnutrition or dehydration was caused by neglect?

Sometimes, patients in nursing homes become malnourished or dehydrated even after the staff takes reasonable measures to prevent it.  On the other hand, these conditions are sometimes the result of outright neglect.

The attorneys at The Gebler Firm, PC have represented many elders who suffered malnutrition or dehydration due to nursing home neglect.  In one case, the facility’s records stated that the patient weighed 125 lbs, and had experienced a 14 lb. weight gain.  The family was relieved, because they were concerned that she appeared to be losing weight.  Tragically, the patient was soon transferred to the emergency room due to infection, where she weighed only 80 lbs upon admission and suffered from severe malnutrition.  She died within days.

Our experience has taught us that you cannot rely upon the weight records of a nursing home.  We frequently find that the recorded weights are not only inaccurate, they are plainly fraudulent.  If a facility is understaffed, the employees will cut corners.  Although required by law, monthly weights are commonly ignored.  To avoid citations from the Health Department, the staff will make false entries on the weight charts to produce at the next on-site investigation. Unfortunately, a patient’s family usually discovers too late that the nursing home has lied to them.

The following are indicators that malnutrition or dehydration may have been caused by neglect:

  • The staff did not assist or encourage the patient to eat or drink.
  • The meals were served cold.
  • The patient was rushed through his meal, or his food tray was removed before he finished (or began) eating.
  • The patient was not weighed at least once every 30 days (more often, if necessary).
  • The family was never informed the patient was losing excessive weight or was dehydrated.
  • Although the patient lost excessive weight, the facility’s weight chart shows little or no change.
  • The doctor was not informed of the patient’s excessive weight loss or dehydration.
  • No effort were made to supplement the patient’s diet with increased calories.
  • The patient’s food intake was either not charted, or falsified.

What can I do if I think my loved one suffered unnecessary malnutrition or dehydration?

If your loved one has died unexpectedly in a long-term care facility due to malnutrition or dehydration, we offer you our sincerest condolences for your loss.  We would be honored to speak with you about your rights, and explain the options that are available.

Contact The Gebler Firm, PC for a free consultation.  We are available to speak with you by phone at 1-800-871-6998, or you may submit an on-line consultation request. We don’t charge any attorney fees unless we obtain a recovery.

We know this is a difficult time, but don’t delay.  The law limits the amount of time you have to pursue legal action.  In some cases, this can be as short as six months.

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Disclaimer:  The information on this site is for informational and educational purposes only.  None of the medical information is intended to be a substitute for professional medical judgment.  A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions.

Injured Elder