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in\t2011\tand\tadopted\tby\tthe\tCenters\tfor\nMedicare\tand\tMedicaid,\t\nFood\tFirst\n!\tis\tthe\tterm\tof\tchoice\tfor\tthis\tapproach.\tTraditionally,\nfortified\tfood\tprograms\thave\tfocused\ton\tadding\tcalories\tand\tprotein\tto\ta\tcouple\tof\tfoods\ton\tthe\nmenu\teach\tday.\tFor\texample,\tcream\tis\tadded\tto\thot\tcereal\tand\tpowdered\tmilk\tis\tadded\tto\tmilk
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(double-strength\tmilk).\tThis\tapproach\tcan\tlead\tto\tlack\tof\tvariety\tand\tfood\tfatigue.\n\tA\tprogram\napproach\tto\tfortifying\tfood\twill\tprovide\tmore\tflexibility\tand\tultimately\tbe\tmore\tsuccessful.\nDigna\tCassens,\tMHA,\tRDN\nModified\tfrom\t\nwww.flavorfulfortifiedfood.com\n.\nNutrition\tscreening\tand\tassessment
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www.flavorfulfortifiedfood.com\n.\nNutrition\tscreening\tand\tassessment\nSimple\tand\teasy-to-use\tnutrition\tscreening\ttools\thave\tbeen\tvalidated\t(\nSkipper\tet\tal,\t2012\n).\tHowever,\nthe\tphysical\tand\tmetabolic\tchanges\tof\taging\tcan\tyield\tinaccurate\tresults.\tExamples\n\tare\nanthropometric\tmeasurements:\theight,\tweight,\tand\tBMI.\tA\tmeta-analysis\tof\tBMI\tand\tall-cause
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mortality\tconcluded\tthat\tbeing\toverweight\twas\tnot\tassociated\twith\tan\tincreased\trisk\tof\tmortality\tin\nolder\tpopulations.\tThe\tmortality\trisk\tincreased\tin\tunderweight\tolder\tpeople,\tthose\twith\ta\tBMI\tof\tless\nthan\t23\t(\nWinter\tet\tal,\t2014\n).\nWith\taging,\tfat\tmass\tincreases\tand\theight\tdecreases\tas\ta\tresult\tof\tvertebral\n\tcompression.\tAn
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] |
compression.\tAn\naccurate\theight\tmeasure\tmay\tbe\tdifficult\tin\tthose\tunable\tto\tstand\tup\tstraight,\tthe\tbed\tbound,\tthose\nwith\tspinal\tdeformations\tsuch\tas\ta\tdowager’s\thump,\tand\tthose\twith\tosteoporosis.\tMeasuring\tarm\nspan\tor\tknee\theight\tmay\tgive\tmore\taccurate\tmeasurements\t(see\t\nAppendix\t11\n).\tBMIs\tbased\ton
|
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] |
Appendix\t11\n).\tBMIs\tbased\ton\nquestionable\theights\tare\tinaccurate\tand\tresult\tis\tmisdiagnosis\tof\tmalnutrition.\tClinical\tjudgment\n\tis\nneeded\tfor\taccuracy.\nThe\t\nMini\tNutritional\tAssessment\t(MNA)\n\tincludes\ttwo\tforms:\ta\tscreening\tShort\tForm\t(MNA-SF)\nand\tthe\tfull\tassessment\t(\nKaiser\tet\tal,\t2009\n).\tThe\tvalidated\tMNA-SF\tis\tthe\tmost\twidely\tused
|
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] |
Kaiser\tet\tal,\t2009\n).\tThe\tvalidated\tMNA-SF\tis\tthe\tmost\twidely\tused\nscreening\tmethod\tto\tidentify\tmalnutrition\tin\tnoninstitutionalized\tolder\tadults\t(see\t\nChapter\t4\n).\tIt\nincludes\tsix\tquestions\tand\ta\tBMI\tevaluation,\tor\ta\tcalf\tcircumference\tif\ta\tBMI\tis\tnot\tpossible.\n\tThe
|
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The\nMNA-SF\tis\tbeing\tused\tas\ta\tscreening\tassessment\ttool\tin\tlong-term\tcare\tand\tis\tespecially\tuseful\tin\nthe\tshort\tstay\tunits.\nNutrition\tneeds\nMany\tolder\tadults\thave\tspecial\tnutrient\trequirements\tbecause\taging\taffects\tabsorption,\tutilization,\nand\texcretion\tof\tnutrients\t(\nBernstein\tand\tMunoz,\t2012\n).\tThe\tdietary\treference\tintakes\t(DRIs)
|
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] |
Bernstein\tand\tMunoz,\t2012\n).\tThe\tdietary\treference\tintakes\t(DRIs)\nseparate\tthe\tcohort\tof\tpeople\tage\t50\tand\tolder\tinto\ttwo\tgroups,\n\tages\t50\tto\t70\tand\t71\tand\tolder.\tThe\ncurrent\tU.S.\tDietary\tGuidelines\tare\tfor\tadults\tin\tgeneral\tand\tcan\tbe\tfound\tin\t\nChapter\t10\n.\tThey
|
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] |
Chapter\t10\n.\tThey\nemphasize\tintake\tof\twhole\tgrains,\tfruit\tand\tvegetables,\tlegumes,\tnuts,\tand\tlow-fat\tdairy\tand\tsuggest\nminimizing\tintake\tof\tfoods\tlow\tin\tsolid\tfats\tand\tadded\tsugars,\tand\tprocessed\tmeat.\tOther\tstudies\nshow\tthat\tolder\tpersons\thave\tlow\tintakes\tof\tcalories,\ttotal\tfat,\tfiber,\n\tcalcium,\tmagnesium,\tzinc,\ncopper,\tfolate,\tand\tvitamins\tB\n12
|
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] |
calcium,\tmagnesium,\tzinc,\ncopper,\tfolate,\tand\tvitamins\tB\n12\n,\tC,\tE,\tand\tD.\tWhen\tchallenged\tby\tdecreased\tappetite,\tearly\tsatiety,\nand\treduced\taccess\tto\tfood,\tmeeting\trecommendations\tcan\tbecome\tdifficult\tfor\tthe\tolder\tadult.\tIt\tis\nvery\timportant\tto\tconsider\tthese\tand\tother\tfactors\twhich\tinhibits\tone’s\tability\tto\tmeet\testimated
|
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] |
needs\tincluding\tsocioeconomic\tstatus,\tdisease\tstate\tand\toverall\thealth,\n\tability\tto\tchew\tand\tswallow,\nand\tability\tto\ttaste.\tIt\tis\tthe\tposition\tof\tthe\tAcademy\tof\tNutrition\tand\tDietetics\tthat\testimated\tneeds\nfor\tolder\tadults\tshould\tbe\tmet\twith\tindividualized\tnutrition\tcare\tplans\tbased\ton\tnutritional\tstatus,
|
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0.06922401487827301,
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] |
be\tthoroughly\tevaluated\tbased\ton\trisk\tand\tbenefit\tto\teach\tindividual\n\t(\nTable\t19.3\n).\nTABLE\t19.3\nNutrient\tNeeds\tChange\twith\tAging\nNutrient\nChanges\twith\tAging\nPractical\tSolutions\nEnergy\nBasal\tmetabolic\trate\tdecreases\twith\tage\nbecause\tof\tchanges\tin\tbody\ncomposition.\nEnergy\tneeds\tdecrease\t3%\tper\ndecade\tin\tadults.
|
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] |
composition.\nEnergy\tneeds\tdecrease\t3%\tper\ndecade\tin\tadults.\nEncourage\tnutrient-dense\tfoods\tin\tamounts\nappropriate\tfor\tcaloric\tneeds.\nProtein\n0.8\tg/kg\nminimum\nMinimal\tchange\twith\tage\tbut\tresearch\nevidence\n\tis\tgrowing\tthat\tthe\tcurrent\nRDA\tis\ttoo\tlow.\tResearchers\tare\nsuggesting\t1.0–1.2\tgm/kg.\nProtein\tintake\tshould\tnot\tbe\troutinely
|
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] |
suggesting\t1.0–1.2\tgm/kg.\nProtein\tintake\tshould\tnot\tbe\troutinely\nincreased;\texcess\tprotein\tcould\nunnecessarily\tstress\taging\tkidneys.\nCarbohydrates\n45%–65%\ntotal\ncalories\nMen\t30\tg\nfiber\nWomen\t21\tg\nfiber\nConstipation\tmay\tbe\ta\tserious\tconcern\nfor\tmany.\nEmphasize\tcomplex\tcarbohydrates:\tlegumes,\nvegetables,\twhole\tgrains,\tfruits\tto\tprovide
|
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] |
vegetables,\twhole\tgrains,\tfruits\tto\tprovide\nfiber,\tessential\tvitamins,\tminerals.\nIncrease\tdietary\tfiber\tto\timprove\tlaxation\nespecially\tin\tolder\tadults.\nLipids\n20%–35%\ntotal\ncalories\nHeart\tdisease\tis\ta\tcommon\tdiagnosis.\nOverly\tsevere\trestriction\tof\tdietary\tfats\nalters\ttaste,\ttexture,\tand\tenjoyment\tof\nfood;\tcan\tnegatively\taffect\toverall\tdiet,
|
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] |
food;\tcan\tnegatively\taffect\toverall\tdiet,\nweight,\tand\tquality\tof\tlife.\nEmphasize\thealthy\tfats\trather\tthan\nrestricting\tfat.\nVitamins\tand\nminerals\nUnderstanding\tvitamin\tand\tmineral\nrequirements,\tabsorption,\tuse,\tand\nexcretion\twith\taging\thas\tincreased\nbut\tmuch\tremains\tunknown.\nEncourage\tnutrient-dense\tfoods\tin\tamounts\nappropriate\tfor\tcaloric\tneeds.
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] |
appropriate\tfor\tcaloric\tneeds.\nOxidative\tand\tinflammatory\tprocesses\naffecting\taging\treinforce\tthe\tcentral\nrole\tof\tmicronutrients,\tespecially\nantioxidants.\nVitamin\tB\n12\n\t2.4\nmg\nRisk\tof\tdeficiency\tincreases\tbecause\tof\nlow\tintakes\tof\tvitamin\tB\n12\n,\tand\tdecline\nin\tgastric\tacid,\twhich\tfacilitates\tB\n12\nabsorption.
|
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] |
12\n,\tand\tdecline\nin\tgastric\tacid,\twhich\tfacilitates\tB\n12\nabsorption.\nThose\t50\tand\tolder\tshould\teat\tfoods\tfortified\nwith\tthe\tcrystalline\tform\tof\tvitamin\tB\n12\nsuch\tas\tin\tfortified\tcereals\tor\nsupplements.\nVitamin\tD\t600-\n800\tIU\n*\nRisk\tof\tdeficiency\tincreases\tas\tsynthesis\nis\tless\tefficient;\tskin\tresponsiveness\nas\twell\tas\texposure\tto\tsunlight
|
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as\twell\tas\texposure\tto\tsunlight\ndecline;\tkidneys\tare\tless\table\tto\nconvert\n\tD\n3\n\tto\tactive\thormone\tform.\tAs\nmany\tas\t30%\tto\t40%\tof\tthose\twith\thip\nfractures\tare\tvitamin\tD\tinsufficient.\nSupplementation\tmay\tbe\tnecessary\tand\tis\ninexpensive.\tA\tsupplement\tis\tindicated\tin\nvirtually\tall\tinstitutionalized\tolder\tadults.\nFolate\t400\tµg
|
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] |
virtually\tall\tinstitutionalized\tolder\tadults.\nFolate\t400\tµg\nMay\tlower\thomocysteine\tlevels;\tpossible\nrisk\tmarker\tfor\tatherothrombosis,\nAlzheimer’s\tdisease,\tand\tParkinson’s\ndisease.\nFortification\tof\tgrain\tproducts\n\thas\timproved\nfolate\tstatus.\tWhen\tsupplementing\twith\nfolate,\tmust\tmonitor\tB\n12\n\tlevels.\nCalcium\t1200\tmg\nDietary\trequirement\tmay\tincrease
|
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] |
12\n\tlevels.\nCalcium\t1200\tmg\nDietary\trequirement\tmay\tincrease\nbecause\tof\tdecreased\tabsorption;\tonly\n4%\tof\twomen\tand\t10%\tof\tmen\tage\t60\nand\tolder\tmeet\tdaily\trecommendation\nfrom\tfood\tsources\talone.\nRecommend\tnaturally\toccurring\tand\nfortified\tfoods.\tSupplementation\tmay\tbe\nnecessary.\tHowever,\tin\tolder\twomen,\thigh\nintakes\tmay\n\tbe\toccurring\twith
|
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] |
intakes\tmay\n\tbe\toccurring\twith\nsupplements.\nPotassium\t4700\nmg\nPotassium-rich\tdiet\tcan\tblunt\tthe\teffect\nof\tsodium\ton\tblood\tpressure.\nRecommend\tmeeting\tpotassium\nrecommendation\twith\tfood,\tespecially\nfruits\tand\tvegetables.\nSodium\t1500\tmg\nRisk\tof\thypernatremia\tcaused\tby\tdietary\nexcess\tand\tdehydration.\nRisk\tof\thyponatremia\tcaused\tby\tfluid\nretention.
|
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0.03774900361895561,
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0.12163862586021423,
0.04826435074210167,
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0.00004185441503068432,
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0.06838534027338028,
0.053296469151973724,
0.07159451395273209,
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] |
Risk\tof\thyponatremia\tcaused\tby\tfluid\nretention.\nNewer\tevidence\tbased\ton\tdirect\thealth\noutcomes\tis\tinconsistent\n\twith\tthe\nrecommendation\tto\tlower\tdietary\tsodium\nin\tthe\tgeneral\tpopulation,\tincluding\tolder\nadults,\tto\t1500\tmg\tper\tday.\tMore\nresearch\tis\tneeded.\n†\nZinc\nMen\t11\tmg\nWomen\t8\tmg\nLow\tintake\tassociated\twith\timpaired
|
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] |
†\nZinc\nMen\t11\tmg\nWomen\t8\tmg\nLow\tintake\tassociated\twith\timpaired\nimmune\tfunction,\tanorexia,\tloss\tof\nsense\tof\ttaste,\tdelayed\twound\thealing,\nand\tpressure\tulcer\tdevelopment.\nEncourage\tfood\tsources:\tlean\tmeats,\noysters,\tdairy\tproducts,\tbeans,\tpeanuts,\ntree\n\tnuts,\tand\tseeds,\tespecially\tpumpkin\nseeds.\nWater\nHydration\tstatus\tcan\teasily\tbe
|
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] |
seeds.\nWater\nHydration\tstatus\tcan\teasily\tbe\nproblematic.\tDehydration\tcauses\ndecreased\tfluid\tintake,\tdecreased\nkidney\tfunction,\tincreased\tlosses\nEncourage\tfluid\tintake\tof\tat\tleast\t1500\nmL/day\tor\t1\tmL\tper\tcalorie\tconsumed.\nRisk\tincreases\tbecause\tof\timpaired\tsense\nof\tthirst,\tfear\tof\tincontinence,\tand
|
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] |
caused\tby\tincreased\turine\toutput\tfrom\nmedications\t(laxatives,\tdiuretics).\nSymptoms:\telectrolyte\timbalance,\naltered\tdrug\teffects,\theadache,\nconstipation,\tblood\tpressure\nchange,\tdizziness,\tconfusion,\tdry\nmouth\tand\tnose.\ndependence\ton\tothers\tto\tget\nbeverages.\tDehydration\tis\toften\nunrecognized;\tit\tcan\tpresent\tas\tfalls,\nconfusion,\tchange\tin\tlevel\tof
|
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] |
unrecognized;\tit\tcan\tpresent\tas\tfalls,\nconfusion,\tchange\tin\tlevel\tof\nconsciousness,\tweakness\tor\tchange\tin\nfunctional\tstatus,\tor\tfatigue.\n*\nNational\tResearch\tCouncil:\tDietary\tReference\n\tIntakes\tfor\tCalcium\tand\tVitamin\tD,\tWashington,\tDC,\t2011,\tThe\tNational\tAcademies\tPress.\n†
|
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] |
†\nNational\tResearch\tCouncil:\tSodium\tintake\tin\tpopulations:\tassessment\tof\tevidence,\tWashington,\tDC,\t2013,\tThe\tNational\tAcademies\tPress.\nBaum\tJ,\tIl-Young\tK,\tWolfe\tR:\tProtein\tConsumption\tand\tthe\tElderly:\tWhat\tIs\tthe\tOptimal\tLevel\tof\tIntake?\tNutrients.\t2016\tJun;\t8(6):\t359.\tPublished\nonline\t2016\tJun\t8.\tdoi:\t10.3390/nu8060359.
|
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] |
online\t2016\tJun\t8.\tdoi:\t10.3390/nu8060359.\nThere\tis\tno\tpredictive\tequation\tspecific\tto\tolder\tadults.\tHowever,\tthe\tMifflin-St.\tJeor\tenergy\nequation\tcan\tbe\tused\tto\tassess\tcalorie\tneeds\tin\thealthy\tolder\tor\tobese\tadults\t(see\t\nChapter\t2\n)\tthough\nit\tcan\toften\toverestimate\tan\tolder\tindividual’s\tneeds.\tA\tquick\tenergy\testimate\tis\tprovided\tin\tthe
|
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] |
table\tbelow.\tCertain\tdisease\tstates\tsuch\tas\tend-stage\trenal\tdisease\ton\tdialysis,\tpressure\tinjuries,\n\tand\ncongestive\theart\tfailure\twarrant\tadjustments\tto\testimated\tneeds\tto\tensure\tadequate\tcalorie,\tprotein,\nand\tfluid\tneeds\tare\tmet.\tAs\twith\tany\tenergy\testimation,\tit\tis\timportant\tto\tcontinue\tto\tmonitor\tweight
|
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and\tconduct\tnutrition-focused\tphysical\tassessments\toften\tto\tensure\testimates\tare\tadequate\tfor\teach\nindividual\t(\nBox\t19.3\n).\nBOX\t19.3\nNutrition\tNeeds\tfor\tOlder\tAdults\nQuick\tCalorie\n\tEstimate\nHealthy\tolder\tadult\n18-22\tkcal/kg\twomen\n20-24\tkcal/kg\tmen\nWeight\tgain\tfor\tunderweight\tor\tolder\tadult\texperiencing\tunintended\tweight\nloss\n25-40\tkcal/kg
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loss\n25-40\tkcal/kg\nPressure\tinjury\n30-35\tkcal/kg\nQuick\tProtein\tEstimate\nHealthy\tolder\tadult\n1.0-1.2\tg/kg\nDialysis\tor\tpressure\tinjury\n1.2-1.5\tg/kg\nQuick\tFluid\tEstimate\nHealthy\tolder\tadult\n25-30\tkcal/kg\tor\t1\nml/kcal\nCongestive\theart\tfailure\n\tor\tedema\n25\tml/kg\nInfection\tor\tfluid\tloss\tfrom\tdraining\twounds\n35\tkcal/kg\nAdapted\tfrom:
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35\tkcal/kg\nAdapted\tfrom:\t\nNutrition\tCare\tof\tthe\tOlder\tAdult:\tA\tHandbook\tfor\tNutrition\tThroughout\tthe\tContinuum\tof\nCare\n,\t3rd\tEd.\tDietetics\tin\tHealth\tCare\tCommunities\tDietetic\tPractice\tGroup;\tKathleen\tC.\tNiedert,\tRDN,\nCSG,\tLD,\tFADA,\tEditor-in-Chief;\tMarla\tP.\tCarlson,\tEditor\nBOX\t19.4\nTypes\tof\tResidential\tHousing
|
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Independ\nent\nLiving\nFacility\n(IL\tor\nILF)\nApartment\tstyle,\tcondominium,\tor\tfreestanding\thome\tliving\tfor\tindependent\tseniors.\nAssisted\nLiving\nFacility\n(AL\tor\nALF)\nApartment\tstyle\thousing\tthat\toffers\torganized\tsocial\tinteraction\tand\tsupport\tservices\tas\nneeded.\tHealth\tcare\tservices\tare\tavailable\tby\toutside\tproviders\twho\tvisit\tthe\tfacility
|
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] |
periodically.\tMeals\tare\toffered\tand\tassistance\twith\tmedication\n\tmanagement\tand\tsome\nphysical\tassistance\twith\tactivities\tof\tdaily\tliving\tand\ttransportation\tcan\tbe\toffered.\nSkille\nd\nNur\nsin\ng\nFac\nility\n(SN\nF)\nNursing\nHome\nAccredited\testablishment\tthat\toffers\t24-hour\tcare\tand\taccess\tto\tin-house\thealth\tcare
|
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providers\tand\tnursing,\tassistance\twith\tactivities\tof\tdaily\tliving,\tmeals\tand\tsnacks,\tand\norganized\tsocial\tactivities.\tMany\tSNFs\talso\tprovide\trehabilitative\tservices\n\twhere\tpatients\ncan\treceive\ttherapy\tand\thealthcare\tservices\tto\trecover\tfrom\tan\tinjury\tor\tillness\twith\tthe\ngoal\tof\treturning\tto\ta\tmore\tindependent\tsetting.\nContinuo\nus\nCare\nRetire\nment
|
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] |
Continuo\nus\nCare\nRetire\nment\nComm\nunity\n(CCRC\n)\nThese\tcommunities\tcombine\tall\tlevels\tof\tcare\tonto\tone\tproperty\tand\tinclude\thousing\tand\nservices\tfor\tindependent,\tassisted,\tand\tskilled\tliving.\nRehabilita\ntion\nHospit\nal\nHospital-like\tsetting\twhich\n\tprovides\textended\tacute\tcare\tfor\tpatients\trequiring\tstabilization
|
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provides\textended\tacute\tcare\tfor\tpatients\trequiring\tstabilization\nbefore\ttransferring\tto\tan\tSNF\tor\tmore\tindependent\tsetting.\tThese\thospitals\tbridge\tthe\ngap\tfor\tpatients\trequiring\tadvanced\ttherapy\tbut\twho\tare\tnot\tappropriate\tto\tstay\tin\ta\ngeneral\thospital\tor\ttransfer\tto\ta\tSNF.\nAdult\nFamily\nHome\n(AFH)
|
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general\thospital\tor\ttransfer\tto\ta\tSNF.\nAdult\nFamily\nHome\n(AFH)\nTraditional\thome\tin\ta\tresidential\tneighborhood\twhich\tsupports\tneeds\tof\tits\tresidents\tby\nassisting\n\twith\tactivities\tof\tdaily\tliving,\tmeals,\tand\tpersonal\tcare.\tMost\tstates\trequire\nlicensing\tand\tare\tinspected\ton\ta\tregular\tbasis,\tthough\tsome\tstates\tdo\tnot\trequire
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licensing\tof\tthese\tfacilities.\tNursing\tcare\tmay\tbe\tavailable\ton\tsite.\tAFHs\ttypically\thouse\nbetween\t2\tand\t9\tresidents\tat\ta\ttime.\nMedicare\tbenefits\nThe\tfederal\tMedicare\tprogram\tcovers\tmost\tof\tthe\thealth\tcare\tcosts\tof\tthose\t65\n\tand\tolder\tand\npersons\twith\tdisabilities.\tHowever,\tthis\tfederally\tfunded\thealth\tinsurance\tprogram\tdoes\tnot\tcover
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the\tcost\tof\tresidential/institutional\tlong-term\tcare.\tA\tportion\tof\tpayroll\ttaxes\tand\tmonthly\tpremiums\ndeducted\tfrom\tSocial\tSecurity\tpayments\tfinance\tMedicare.\nMedicare\tbenefits\tare\tprovided\tin\tfour\tparts.\tPart\tA\tcovers\tinpatient\thospital\tcare,\tsome\tskilled\nnursing\tcare\tfor\tspecific
|
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nursing\tcare\tfor\tspecific\n\t“skilled\tservices”,\thospice\tcare,\tand\tsome\thome\thealth\tcare\tcosts\tfor\nlimited\tperiods\tof\ttime.\tIt\tis\tpremium\tfree\tfor\tmost\tcitizens.\tPart\tB\thas\ta\tmonthly\tpremium\tthat\thelps\npay\tfor\tphysicians\tand\tphysician\tsurrogates,\toutpatient\thospital\tcare,\tand\tsome\tother\tcare\tnot
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] |
covered\tby\tPart\tA\t(physical\tand\toccupational\ttherapy,\tfor\texample).\tPart\tC\tallows\tprivate\tinsurers,\nincluding\thealth\tmaintenance\torganizations\n\t(HMOs)\tand\tpreferred\tprovider\torganizations\t(PPOs),\tto\noffer\thealth\tinsurance\tplans\tto\tMedicare\tbeneficiaries.\tThese\tmust\tprovide\tthe\tsame\tbenefits\tthe
|
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] |
original\tMedicare\tplan\tprovides\tunder\tParts\tA\tand\tB.\tPart\tC\tHMOs\tand\tPPOs\talso\tmay\toffer\nadditional\tbenefits,\tsuch\tas\tdental\tand\tvision\tcare.\tPart\tD\tprovides\tprescription\tdrug\tbenefits\nthrough\tprivate\tinsurance\tcompanies.\nThe\t\n2010\tAffordable\tCare\n\tAct\n\t(see\t\nChapter\t9\n)\tchanged\tMedicare\tto\tinclude\tan\tannual\twellness
|
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] |
(see\t\nChapter\t9\n)\tchanged\tMedicare\tto\tinclude\tan\tannual\twellness\nvisit\tand\ta\tpersonalized\tprevention\tassessment\tand\tplan\twith\tno\tcopayment\tor\tdeductible.\nPrevention\tservices\tinclude\treferrals\tto\teducation\tand\tpreventive\tcounseling\tor\tcommunity-based\ninterventions\tto\taddress\trisk\tfactors.\tExpansion\tof\tmedical\tnutrition\ttherapy\treimbursement\tfor
|
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] |
Medicaid,\tfor\tqualified\tlow-income\tindividuals,\tfinances\ta\tvariety\tof\tlong-term\tcare\tservices\tvia\nmultiple\tmechanisms,\tincluding\tMedicaid\tState\tPlans\tand\t\nhome-\tand\tcommunity-based\tservices\n(HCBS)\twaivers\n,\tSection\t1915\t(c).\tBoth\tprovide\tservice\tto\tnursing\thome–appropriate\tolder\tadults
|
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to\thelp\tprevent\tor\tdecrease\tnursing\thome\tor\tinstitutionalization.\tStates\tmay\toffer\tan\tunlimited\nvariety\tof\tservices\tunder\tthis\twaiver.\tThese\tprograms\tmay\tprovide\ttraditional\tmedical\tservices\n(dental,\tskilled\tnursing)\tand\tnonmedical\tservices\t(meal\tdelivery,\tcase\tmanagement,\tenvironmental
|
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modifications).\tStates\thave\tthe\tdiscretion\tto\tchoose\tthe\tnumber\tof\tolder\tpersons\tserved\tand\tthe\nservices\toffered.\nProgram\tof\tAll-Inclusive\tCare\tfor\tthe\tElderly\t(PACE)\tis\ta\tcomprehensive\tmanaged\tcare\tsystem\tfor\npeople\tover\t55\twho\tare\tnursing\thome\teligible\tand\twho\tmeet\tlow\tincome\tcriteria.\tThe\tprogram\tis
|
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funded\tthrough\tMedicare\tand\tMedicaid.\tCoordinated\tpreventive,\tprimary,\tacute,\tand\tlong-term\n\tcare\nservices\tallow\tolder\tadults\tto\tremain\tin\ttheir\thomes\tfor\tas\tlong\tas\tpossible\t(\nThomas\tand\tBurkemper,\n2013\n).\tThe\tPACE\tmodel\tis\tbased\ton\tthe\tbelief\tthat\tit\tis\tbetter\tfor\tthe\twell-being\tof\tolder\tadults\twith
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] |
placement\twhenever\tpossible.\tThe\tU.S.\tAdministration\ton\tAging\tis\tnow\tunder\tthe\tnew\tumbrella\tof\nthe\tU.S\tAdministration\ton\tCommunity\tLiving.\tTerms\tsuch\tas\t“aging\tin\tcommunity,”\t“communitarian\nalternatives,”\t“age-friendly\tliving,”\t“care\tcircles,”\tand\tespecially\t“\nlong-term\tservices\tand\nsupports\n”\t\n(LSS)\n\t(versus\t“long-term\tcare”)
|
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] |
long-term\tservices\tand\nsupports\n”\t\n(LSS)\n\t(versus\t“long-term\tcare”)\n\tare\tindicative\tof\tthe\ttransformations\ttaking\tplace\tin\tthe\nmore\tpositive\tapproaches\tto\taging\t(\nBernstein\tet\tal,\t2012\n;\t\nRudolph,\t2009\n).\nNutrition\tsupport\tservices\nU.S.\tdepartment\tof\thealth\tand\thuman\tservices\tolder\tAmericans\tact\t(OAA)\tnutrition\nprogram
|
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] |
program\nThe\tOAA\twas\toriginally\tenacted\tin\t1965\tand\tapproved\tfor\ta\t3-year\treauthorization\tin\t2015\tby\nunanimous\tvote\tby\tthe\tSenate.\tThe\tOAA\tNutrition\tProgram\n\tis\tthe\tlargest,\tmost\tvisible\tfederally\nfunded\tcommunity-based\tnutrition\tprogram\tfor\tolder\tpersons\t(\nLloyd\tand\tWellman,\t2015\n).\tPrimarily\ta
|
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Lloyd\tand\tWellman,\t2015\n).\tPrimarily\ta\nstate-run\tprogram,\tit\thas\tfew\tfederal\tregulations\tand\tconsiderable\tvariation\tin\tstate-to-state\tpolicies\nand\tprocedures.\tGoals\tof\tthe\tOAA\tinclude\tsupporting\tseniors’\tindependence\tand\thelping\tprevent\nhospitalization\tand\tnursing\tcare\twith\tfunding\textending\tto\t56\n\tstate\tagencies,\tover\t200\ttribal
|
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state\tagencies,\tover\t200\ttribal\norganizations,\tand\tover\t20,000\tlocal\tservice\tproviders.\tNutrition\tprogram\tfunding\tis\tdistributed\nbased\ton\ta\tformula\twhich\tconsiders\teach\tstate’s\tpopulation\tof\tolder\tadults\tover\tage\t60.\tThis\nnutrition\tprogram\tprovides\tcongregate\tand\thome-delivered\tmeals\t(usually\t5\tdays\tper\tweek\tusing
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Meals\ton\tWheels),\tnutrition\tscreening,\teducation,\tand\tcounseling,\tas\twell\tas\tan\tarray\n\tof\tother\nsupportive\tand\thealth\tservices.\tThe\tOAA\tNutrition\tProgram,\tavailable\tto\tall\tpersons\tage\t60\tand\nolder\tregardless\tof\tincome,\tsuccessfully\ttargets\tthose\tin\tgreatest\teconomic\tand\tsocial\tneed,\twith
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] |
particular\tattention\tto\tlow-income\tminorities\tand\trural\tpopulations.\tGenerally,\ta\thigher\tproportion\tof\nolder\tadults\twho\treceive\tOAA\tservices\thave\ta\thigher\tpercent\tof\tfood\tinsecurity\tand\tfunctional\nlimitations\tcompared\twith\tthose\twho\tdo\tnot\tutilize\tservices\t(\nVieira\tet\tal,\t2017\n).\tParticular\tattention
|
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Vieira\tet\tal,\t2017\n).\tParticular\tattention\nis\tpaid\tto\tthose\tindividuals\twho\tare\tmembers\tof\tminority\tgroups,\tlive\tin\trural\tareas,\thave\tlow\nincome,\thave\tlimited\tEnglish\tproficiency,\tand\tare\tat\trisk\tfor\tinstitutional\tcare.\nMore\tthan\thalf\tof\tthe\tOAA\tannual\tbudget\tsupports\tthe\tnutrition\tprogram,\twhich\tprovides\tabout\n219\tmillion\tcongregate
|
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] |
219\tmillion\tcongregate\n\tand\thome-delivered\tmeals\tto\t2.4\tmillion\tolder\tadults\tannually\t(\nU.S.\nAdministration\ton\tAging,\t2019\n).\tAccording\tto\tthe\tACL\tand\tU.S.\tAdministration\ton\tAging,\t91%\tof\nparticipants\tstated\tthat\thome-delivered\tmeals\thave\thelped\tthem\tstay\tin\ttheir\town\thomes\tand\tmore
|
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] |
than\t60%\tof\tparticipants\tindicate\tthat\thome-delivered\tmeals\tprovide\tone\thalf\tor\tmore\tof\ttheir\ttotal\nintake\tfor\tthe\tday.\tHome-delivered\tmeals\n\thave\tgrown\tto\tmore\tthan\t61%\tof\tall\tmeals\tserved\tand\nalmost\thalf\tof\tthe\tprograms\thave\twaiting\tlists.\tTo\treceive\thome-delivered\tmeals,\tan\tindividual\tmust
|
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be\tassessed\tto\tbe\thome\tbound,\tfrail,\tor\tisolated,\tthough\tthe\tbenefits\tmay\talso\textend\tto\tcaregivers,\nspouses,\tand\tpeople\twith\tdisabilities.\nAt\tcongregate\tsites,\tthe\tnutrition\tprogram\tprovides\taccess\tand\tlinkages\tto\tother\tcommunity-based\nservices.\n\tIt\tis\tthe\tprimary\tsource\tof\tfood\tand\tnutrients\tfor\tmany\tprogram\tparticipants\tand\tpresents
|
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] |
opportunities\tfor\tactive\tsocial\tengagement\tand\tmeaningful\tvolunteer\troles.\tThe\tmeals\tprovided\tare\nrequired\tto\tbe\tnutritionally\tdense,\tsupply\tmore\tthan\t33%\tof\tthe\trecommended\tdietary\tallowances\n(an\tOAA\trequirement),\tand\tprovide\t40%\tto\t50%\tof\tdaily\tintakes\tof\tmost\tnutrients\t(\nLloyd\tand\nWellman,\t2015\n).\nThe\tOAA
|
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] |
Lloyd\tand\nWellman,\t2015\n).\nThe\tOAA\n\tNutrition\tProgram\tis\tclosely\tlinked\tto\tHCBS\tthrough\tcross-referrals\twithin\tthe\tAging\nNetwork.\tBecause\tolder\tadults\tare\tbeing\tdischarged\tearlier\tfrom\thospitals\tand\tnursing\thomes,\tmany\nrequire\ta\tcare\tplan\tthat\tincludes\thome-delivered\tmeals\tand\tother\tnutrition\tservices\t(e.g.,\tnutrition
|
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screening,\tassessment,\teducation,\tcounseling,\tand\tcare\tplanning).\tMany\tstates\tare\tcreating\nprograms\tto\tprovide\tnecessary\n\tmedical,\tsocial,\tand\tsupportive\tHCBS,\tincluding\thome-delivered\nmeals,\tnutrition\teducation,\tand\tcounseling\tservices.\tStates\tare\tbeing\tencouraged\tto\thelp\tolder
|
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adults\tand\tpeople\twith\tdisabilities\tlive\tin\ttheir\thomes\tand\tfully\tparticipate\tin\ttheir\tcommunities\tby\nthe\tACL.\tIts\trole\tis\tto\tbuild\tthe\tcapacity\tof\tthe\tnational\taging\tand\tdisability\tnetworks\tto\tbetter\tserve\nolder\tpersons,\tcaregivers,\n\tand\tindividuals\twith\tdisabilities.\nU.S.\tdepartment\tof\tagriculture\t(USDA)\tfood\tassistance\tprograms
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the\tmonth\twhen\tfinances\tdiminish.\tSeveral\tUSDA\tfood\tand\tnutrition\tassistance\tprograms\tare\navailable\n\tto\tolder\tadults\tafter\tparticipants\tmeet\tcertain\tcriteria\tas\tall\tUSDA\tprograms\tare\tmeans\ntested.\tA\trecent\tstudy\tsuggests\tthat\tolder\tadults\tdually\tenrolled\tin\tMedicare\tand\tMedicaid\tservices
|
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who\treceive\tSNAP\tbenefits\thad\treduced\thospitalization\tand\temergency\tdepartment\tvisits\tcompared\nwith\tthose\tthat\tdid\tnot\tutilize\tthese\tbenefits\t(\nSamuel\tet\tal,\t2018\n).\tThis\tcould\thave\tsignificant\nimplications\ton\n\tthe\tgeneral\thealth\tof\tolder\tadult\tpopulations,\tthough\tthe\tmajority\tof\tU.S.\tadults\twho
|
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are\teligible\tfor\tSNAP\tbenefits\tdo\tnot\tparticipate.\tAdditional\tinformation\ton\tUSDA\tfood\tassistance\nprograms\tcan\tbe\tfound\tin\t\nChapter\t9\n.\nCommodity\tsupplemental\tfood\tprogram\nThe\tCommodity\tSupplemental\tFood\tProgram\t(CSFP)\tstrives\tto\timprove\tthe\thealth\tof\tlow-income
|
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] |
frequently\tlacking\tin\tlow-income\tdiets\tand\tcan\tinclude\tdry\tmilk,\tjuice,\toats,\tdry\tcereal,\trice,\tpasta,\npeanut\tbutter,\tdry\tbeans,\tcanned\tmeat/poultry/fish,\tand\tcanned\tfruits\tand\tvegetables.\nSeniors\tfarmers’\tmarket\tnutrition\tprogram\nThe\tSeniors\tFarmers’\tMarket\n\tNutrition\tProgram\t(SFMNP)\tis\tadministered\tby\tstate\tdepartments\tof
|
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] |
Nutrition\tProgram\t(SFMNP)\tis\tadministered\tby\tstate\tdepartments\tof\nagriculture,\taging\tand\tdisability\tservices,\tor\tfederally\trecognized\tNative\tAmerican\ttribal\ngovernments.\tNot\tall\tstates\toperate\tSFMNP\ton\ta\tstatewide\tbasis.\tSFMNP\tprovides\tcoupons\tto\tlow-\nincome\tolder\tindividuals\tto\tpurchase\tfresh\tunprepared\tfruits,\tvegetables,\thoney,\tand\therbs\tat
|
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farmers’\tmarkets,\troadside\tstands,\tand\tcommunity-supported\n\tagriculture\t(CSA)\tprograms.\tIt\nprovides\teligible\tolder\tadults\twith\tlocal,\tseasonal\taccess\tto\tfresh\tfruits\tand\tvegetables\tas\twell\tas\nnutrition\teducation\tand\tinformation.\tThe\tSFMNP\tserves\tlow-income\tolder\tadults\twho\tare\tgenerally
|
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] |
these\tneeds.\tSome\tMedicaid-\nbased\thealth\tplans\tare\talso\tincreasing\ttheir\tinvolvement\twith\tnutrition\tprofessionals,\tassisting\tplan\nmembers\tin\tSNAP\tenrollment\tand\tutilizing\tassessment\tdata\tto\tmonitor\tnutrition-related\tneeds\tand\noutcomes\t(\nCenter\tfor\tHealthcare\tStrategies,\t2019\n).\nCommunity\tand\tresidential\tfacilities\tfor\tolder\tadults\nThe\treport
|
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).\nCommunity\tand\tresidential\tfacilities\tfor\tolder\tadults\nThe\treport\t\nLong-Term\tCare\tProviders\tand\tServices\tUsers\tin\tthe\n\tUnited\tStates,\t2015-2016\n\tfound\tthat\n65,600\tpaid,\tregulated\tlong\tterm\tservices\tproviders\tserved\tover\t8.3\tmillion\tpeople\t(\nHarris-Kojetin\tet\nal,\t2016
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Harris-Kojetin\tet\nal,\t2016\n).\tThis\tis\tin\tan\tincrease\tof\t7,100\tservice\tproviders\tsince\t2013.\tLong\tterm\tcare\tservices\twere\nprovided\tby\t4,600\tadult\tday\tservices,\t12,200\thome\thealth\tagencies,\t4,300\thospices,\t15,600\tnursing\nhomes\tand\t28,900\tassisted\tliving\tand\tsimilar\tresidential\tcare\n\tcommunities.\tEach\tday,\tthere\tare\tmore
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] |
communities.\tEach\tday,\tthere\tare\tmore\nthan\t286,300\tenrolled\tadult\tday\tservice\tparticipants,\t1,347,600\t\nskilled\tnursing\tfacilities\t(SNFs)\nresidents\t(for\tthose\trequiring\ta\thigher\tlevel\tof\tmedical\tcare),\tand\t811,500\tresidential\tcare\tresidents.\nIn\t2015,\tapproximately\t1,426,000\tpatients\treceived\tservices\tfrom\thospices,\ta\t14%\tincrease\tfrom\n2013.
|
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] |
2013.\nPeople\tmove\tto\tresidential\tfacilities,\tgenerally\tknown\n\tas\tassisted\tliving,\twhen\tthey\tcan\tno\tlonger\nsafely\tlive\talone\tbecause\tthey\thave\tsome\tcognitive\timpairment\trequiring\tsupervision\tor\tneed\thelp\nwith\tADLs\tbecause\tof\timmobility.\tCare\tis\tprovided\tin\tways\tthat\tpromote\tmaximum\tindependence\tand
|
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] |
dignity.\tAssisted\tliving\tcare’s\tannual\tcost\tis\tgenerally\tquite\ta\tbit\tless\tthan\tnursing\thomes.\tResidents\nare\tencouraged\tto\tmaintain\tactive\tsocial\tlives\twith\tplanned\n\tactivities,\texercise\tclasses,\treligious\tand\nsocial\tfunctions,\tand\topportunities\tto\ttravel\toutside\tthe\tfacility.\tThese\tcommunities\tare\tnow\trequired
|
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in\tsome\tstates\tto\tprovide\ttherapeutic\tdiets\tbut\tin\tthose\tstates\twithout\tsuch\tregulation\tresidents\thave\ndifficulty\tgetting\tspecial\trequirements\tmet\tfor\tservices\tsuch\tas\ttexture\tmodified\tmeals.\nComprehensive\tstate\tregulations\tfor\tfood\tand\tnutrition\tservices\n\tin\tassisted\tliving\tcare\tis\tnot\tyet
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planning\tto\tmeet\tspecial\tneeds\tsuch\tas\ttype\tand\tamounts\tof\n\tmacronutrients\tand\tmicronutrients,\ntexture\tmodifications,\tand\tquality\tof\tfood\tchoices\tand\tpresentation.\nOnly\tabout\t3%\tor\t1.4\tmillion\tolder\tadults\tlive\tin\tthe\tapproximately\t15,700\tnursing\thomes\t(\nHarris-\nKojetin\tet\tal,\t2019
|
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Harris-\nKojetin\tet\tal,\t2019\n).\tThe\tpercentage\tof\tthe\tpopulation\tthat\tlives\tin\tnursing\thomes\tincreases\ndramatically\twith\tage,\tespecially\tfor\tthose\tolder\tthan\tage\t85.\tHowever,\tthe\toverall\tpercentage\thas\ndeclined\n\tsince\t1990,\tlikely\tbecause\tof\thealthier\taging,\tthe\tfederal\tcost-containment\tpolicy\tto\tdelay
|
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] |
residential\tplacement\tin\tnursing\thomes\tby\tproviding\tmore\taging\tservices\tin\tthe\tcommunity,\tas\twell\nas\tthe\tincreased\tavailability\tand\tuse\tof\thospice.\tThe\tpercentage\tincreases\twith\tage,\tranging\tfrom\t1%\nfor\tpersons\tage\t65\tto\t74\tyears\tto\t3%\tfor\tpersons\tage\t75\tto\t84\tyears\tand\t10%\tfor\tpersons\tage\t85.\tThe\ncost
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] |
cost\n\tof\tnursing\thome\tcare\tdiffers\tby\tstate\twith\tthe\tmost\texpensive\treported\tin\tAlaska\twhere\ta\nsemiprivate\troom\tis\tmore\tthan\t$23,000\tper\tmonth\tand\tthe\tleast\texpensive\tis\tOklahoma\tat\tabout\n$4500\tper\tmonth\t(\nSeniorliving.org\n).\nSNFs\tare\tfederally\tregulated\tby\tthe\tCenters\tfor\tMedicare\tand\tMedicaid\tServices;\tassisted\tliving
|
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0.004677113611251116
] |
centers,\tby\teach\tstate.\tMore\tresidents\tare\tin\tSNFs\tfor\tshort-stay,\tpost-acute\tcare,\n\tthus\tmore\ncomprehensive\tmedical\tnutrition\ttherapy\tis\tnow\tneeded.\tNutritional\tcare\tis\tdirected\ttoward\nidentifying\tand\tresponding\tto\tchanging\tphysiologic\tand\tpsychological\tneeds\tover\ttime\tthat\tprotect\nagainst\tavoidable\tdecline\t(\nBox\t19.4\n).
|
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] |
against\tavoidable\tdecline\t(\nBox\t19.4\n).\nThe\tculture\tchange\tmovement\tin\tlong-term\tcare\t(LTC)\n\thas\tled\tto\tthe\tcreation\tof\tthe\t\nDining\nPractice\tStandards\t(DPS)\n.\tThe\tDPS\twere\tpublished\tby\tthe\tPioneer\tNetwork’s\n\tDining\tClinical\tTask\nForce,\ta\tmultidisciplinary\tgroup\tof\tLTC\tand\tnutrition\texperts.\tThese\tguidelines\twere\tagreed\tto\tby
|
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Centers\tfor\tMedicare\tand\tMedicaid\tServices\t(CMS)\tand\tover\ta\tdozen\tprofessional\tgroups,\tincluding\nthe\tAcademy\tof\tNutrition\tand\tDietetics\t(AND).\tThe\tguidelines\tprovide\tevidence-based\tsupport\tfor
|
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resident-centered\tdining,\tfor\tliberalized\tdiets,\tfor\tfood\tfirst,\tand\tfor\tdecreased\n\tdependence\ton\nmedical\tnutritional\tsupplements.\tCMS\thas\tsubsequently\tincorporated\tthe\tDPS\tinto\tthe\tsurvey\nprocess.\nIn\t1987\tCongress\tpassed\treform\tlegislation\tas\tpart\tof\tthe\tOmnibus\tReconciliation\tAct\t(OBRA)\tto
|
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improve\tthe\tquality\tof\tcare\tin\tSNFs\tby\tstrengthening\tstandards\tthat\tmust\tbe\tmet\tfor\nMedicare/Medicaid\treimbursement.\tSince\tthat\ttime\tSNFs\thave\tbeen\trequired\tby\tCMS\tto\tconduct\nperiodic\tassessments\n\tto\tdetermine\tthe\tresidents’\tneeds;\tto\tprovide\tservices\tthat\tensure\tresidents
|
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] |
maintain\tthe\thighest\tpractical,\tphysical,\tmental,\tand\tpsychological\twell-being;\tand\tto\tensure\tthat\tno\nharm\tis\tinflicted.\tThis\tis\taccomplished\tusing\tthe\t\nMinimum\tData\tSet\t(MDS)\n,\twhich\tis\tpart\tof\tthe\nfederally\tmandated\tprocess\tfor\tclinical\tassessment\tof\tresidents\tof\tLTC\tfacilities\tlicensed\tunder\nMedicare\tor\tMedicaid.\tSection
|
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] |
Medicare\tor\tMedicaid.\tSection\n\tK\tof\tthe\tMDS\tis\tspecific\tto\tnutrition\tand\tis\tgenerally\tthe\nresponsibility\tof\tthe\tdietitian\tto\tcomplete\tbut\tcan\tbe\tdone\tby\tnursing\tstaff\t(\nFig.\t19.4\n).\tThis\tform\ndocuments\t“triggers”\tthat\tmay\tplace\ta\tresident\tat\tnutrition\trisk\tand\ttherefore\trequires\tan
|
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intervention.\tThis\tassessment\tmust\tbe\tdone\tat\tadmission\tand\tif\tthere\tis\ta\tsignificant\tchange\tin\tthe\nresident’s\tcondition\tsuch\tas\tweight\tloss\tor\tskin\n\tbreakdown.\tReassessment\tis\trequired\tquarterly\tand\nannually.\tThe\tentire\tprocess\tis\tknown\tas\tthe\t\nResident\tAssessment\tInstrument\t(RAI)\n.\tIt\tprovides
|
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Resident\tAssessment\tInstrument\t(RAI)\n.\tIt\tprovides\nthe\tindividual\tassessment\tof\teach\tresident’s\tfunctional\tcapabilities\tand\thelps\tidentify\tproblems\tand\ndevelop\ta\tcare\tplan.\nFIG.\t19.4\nThe\tMinimum\tData\tSet,\tSection\tK\tversion\t3.0.\n\t\nSource:\n\t(From\tthe\tCenters\tfor\tMedicare\tand\tMedicaid\tServices,\nBaltimore,\tMD.)
|
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] |
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