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Federal Regulations on Food and Nutrition Guidelines in Nursing Homes

According to the federal regulation titled 42 CFR § 483.60, nursing homes must comply with food and nutrition guidelines to provide each resident with a balanced diet that is catered to each resident’s nutritional needs or dietary restrictions. Additionally, staff must take into account the resident’s preferences. 


These regulations outline specific requirements for staff including education, skills, and knowledge to ensure the employee can properly care for residents. Dietitians or nutrition professionals working full or part-time, or as a consultant, must hold a Bachelor’s Degree from a United States accredited college or university, or equivalent from a foreign country. They must also complete at minimum 900 hours of nutrition work under guidance of registered professionals and become licensed or certified in the state they work. 

If the dietitian is not working full-time, the nursing home must have a director of nutrition and food that is certified or has higher education related to these services. The director must create appropriate standards for food staff and frequently employ a consultant, either a certified dietitian or nutrition professional. 

The nursing home is required to provide support staff to perform all of these essential services. 

Interdisciplinary Teams

This federal regulation requires a member of the Food and Nutrition Services team to engage on interdisciplinary teams. 


The regulation has strict guidelines for menus describing how the menu must:

– Accurately serve the needs of the residents and comply with national established standards

– Be created in advance by staff

– Always be followed by staff

– Practice inclusivity of different religions, backgrounds, and cultures 

– Be consistently updated 

– Have approval from dietitians or nutrition professionals

– Never hinder a resident’s ability to choose their preferred diet

Food and Drinks

Additionally, there is an outline for what the nursing home is required to provide for its residents, including:

– Food prepared with cooking procedures that enhance flavors, looks, and nutrition

– Appropriate temperature for food

– Individualized foods needs 

– Avoidance of food allergens or irritants

– Several options with similar dietary value

– Water and several other liquids to ensure residents are hydrated

Therapeutic Diets

Facility physicians may require therapeutic diets for senior residents with certain conditions. The physicians can allocate the responsibility of therapeutic diets to the licensed and certified staff. 

Frequency of Meals

The nursing home is required to provide at least three options for meal times, similar to conventional eating structure or cater to the needs of the individual residents. The staff must provide breakfast within 14 hours of serving dinner, unless a large snack has been given the previous night. Some residents may eat at odd times and staff must accommodate these needs with snacks and meals following the same regulations. 

Assistive Devices

If any resident needs specialized tools to eat, the staff must readily supply this equipment. 

Paid Feeding Assistants 

Feeding assistants must be trained in a State-approved class and the nursing home may employ the assistant if the assistant has passed the course and it complies with State law. Nurses must oversee the work of feeding assistants. Feeding assistants can only serve residents with no severe medical conditions that could complicate feeding. The interdisciplinary team decides the residents based on previous assessments and care needs. 

Food Safety Requirements 

Several food safety regulations must be followed by the facility’s staff, including:

– Sources of food are approved and deemed safe by authorities.

– Food may be from local producers or facilities can even grow produce on facility grounds as long as it complies with safe practices

 – Storage, handling, distribution, and serving of food must be in compliance with professional food service safety guidelines

– Food from family and visitors must adhere to safe storage, preparation, and consumption standards

– Waste must be properly handled 

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