Blue-plate specialists: CMS proposes plan for "feeding assistants". (Newsfronts).

A CENTERS FOR MEDICARE AND MEDICAID Services (CMS) proposal announced March 28 by HHS Secretary Tommy G. Thompson will allow nursing homes to employ trained "single-task" assistants to help residents eat and drink.

"Allowing trained feeding assistants will mean better care for residents, especially at mealtimes, which can be the busiest times in nursing homes," Secretary Thompson said in a statement. "Trained feeding assistants will free nurses and nurse aides to focus on residents' other health care needs. The result will be that residents will receive better nutrition and care."

Under the CMS proposal, individuals would be required to complete a state-approved course to qualify as trained feeding assistants.

Long term care industry spokesmen have praised the CMS plan as having the potential to help relieve severe staffing shortages in many facilities. Charles Roadman II, MD, president and CEO of the American Health Care Association, states that "We are very pleased this pro-patient, pro-quality care initiative has been put in place, particularly at a time when recruiting, training, and employing qualified nursing staff is a paramount national challenge."

According to Ruta Kadonoff, a health-policy analyst for the American Association of Homes and Services for the Aging (AAHSA), the feeding-assistants plan would allow administrators and other non-medical staff within nursing facilities to pitch in at mealtime. "Until now, unless they went through the entire 75-hour nurse-aide program, they were not eligible to do that," says Kadonoff.

CMS envisions that other potential feeding assistants might include homemakers, retirees, and older students who are available for a few hours a day.

Consumer advocates opposed

The National Citizens' Coalition for Nursing Home Reform (NCCNHR), a Washington, D.C.-based consumer-advocacy group, has denounced the CMS proposal as "reckless and unnecessary."

Donna R. Lenhoff, executive director of NCCNHR, comments that "In a month when we have seen an unprecedented series of government studies and hearings about nursing home neglect and abuse and the need for higher staffing standards, the Secretary wants to reverse 15 years of modest progress in improving the qualifications of nursing home workers. Creating a new category of worker who is even more poorly trained, poorly screened, and poorly paid than nurse aides is not the answer to staffing or quality-of-care problems."

AAHSA's Kadonoff counters that it is premature to assume that feeding assistants would not be adequately trained. "The CMS rule actually calls for the [state-approved] training programs to be fairly comprehensive, including interpersonal skills and dealing with resident behaviors, safety, and infection control," she says.

The CMS proposal, as published in the Federal Register, March 29, 2002, also states that an RN must evaluate each resident daily, if necessary, to determine whether he or she needs help eating and drinking, and whether a feeding assistant is equal to the task. CMS also asserts that feeding assistants must work only under direct supervision of licensed personnel.