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She has orders for sugar free and low carb meals selected, but they are completely ignored. At every meal she is given sugar sweetened lemonade and tea and desserts and tons of carbs. Then the staff gives her a hard time for refusing to eat those items. I am having to pay out of pocket to buy her food that won't destroy her health further and I am already strapped. I'm guessing their food budget is tiny. I worked at a facility like this as a chef and the budget was $5.00 per resident per day for all meals combined not for each meal, but for all meals total. They gave me a menu designed by a dietitian I had to follow but the budget wasn't even enough to order what I needed to follow the menu. I left after 3 months. I don't understand why they would have standing orders where my mom is staying for nutrition if they are unable to meet them. Can anyone give me some advice?


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I understand. We had to let the staff and dietician know several times that my MIL didn't like sweet tea to begin with, and she would not drink it if it was on her tray. After a few months of letting them know what she could eat and drink, they finally settled into a routine of bringing her better food. She still preferred the food that we brought in, but then again, who wouldn't? The food there was not that appealing to the senses, unfortunately.
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anonymous1732518 Nov 11, 2023
Sounds like the food here.

They serve whole milk or 2 percent milk. The very rare time they had skin or non fat, the skin had spoiled. Non fat was there one day gone the next; they have even served chocolate milk at dinner.
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You need to contact the Ombudsman if you have already had a meeting with the Executive Director and the Director of Nursing.
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anonymous1732518 Nov 11, 2023
Dietitian should be doing this
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Wow! What a challenging situation.

How in the world can specific dietary requirements be met on such a limited budget?

Not only that, but this is getting ridiculously expensive for you.

I am assuming that you have already spoken with the DON and the kitchen staff about this matter or have you?

Is everything processed in her nursing home? Could she get fresh fruit instead of sweet lemonade? Why can’t they do a pitcher of unsweetened tea? Do you think that she would like herbal tea unsweetened? I love herbal teas.

Personally, I don’t like sweet tea. I drink mine plain. If your mom doesn’t like it plain then she could add a sweetener that is approved for diabetics.

Wishing you and your mom all the best.
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anonymous1732518 Nov 11, 2023
😆 Money. Many of the residents probably don't eat the food anyway so why spend big bucks for decent food the bulk of which will be tossed.

A good example, there is a local ice cream factory that's been in business for over 100 years, yet the facility orders from an out of state company. Vanilla flavored and chocolate ice cream head to the trash.

another example white bread, since it is probably cheaper then wheat, same with whole or 2 percent milk. Fresh fruits and veggies, very rarely.

You should see the food wasted on the trays waiting to be thrown out
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I imagine that a good number of the residents are in the same situation.
Lo carb, low sugar, low sodium, low fat and then you get into allergy problems and other diet restrictions due to religious reasons.
I would take this up with the Ombudsman in the state you are in.

It would be interesting to see what would happen if mom had a problem due to the high sugar and if that resulted in a transport to the hospital..would the facility be to blame?
If it caused her an extended hospitalization of even her death would the facility be liable?

I think this should also be brought up and discussed when there is a Care Plan meeting.
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Your profile says that your mom is only 64 years old(my age)and doesn't have(from what you've listed)any major health issues that she should be living in a skilled nursing facility at such a young age.
Can you explain better why this is the only option for your mom? Why is she not able to live on her own, or is she just in it for some type of rehab?
And if it's just for rehab be grateful that she'll be out soon. But if this is now her permanent home(again I'm not understanding why)I guess you'll just have to continue to talk to the director and the person in charge of the kitchen to try to get her some more healthy food options.
And please don't be spending your own money for her food. Your mom should be paying for her own food if she wants/needs something different from what she's getting at the facility.
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anonymous1732518 Nov 11, 2023
I was with you until your last sentence. Mom and/ or her insurance is paying for this. She should have a choice what she wants to and not want to eat, with a healthier choice being available.

The dietitian is the one who should have met with mom to set up her meal plan.

The lack of change falls on him or her.
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One of the to things many don't know about SNF living
If your mom's facility is similar to many, they're probably understaffed in the kitchen. Depending on how many residents they are serving, they may find it easier to give the residents with special diets the same food as those without .

Many residents probably waste the food anyway, so some SNFs may feel why bother?
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NeedHelpWithMom Nov 11, 2023
Cover,

Has your situation improved regarding your dietary needs?

I am sure lots of residents have special dietary requirements. Such as allergies, lactose intolerance, diabetes, high blood pressure, high cholesterol, etc.

I wonder how they are able to handle specific preferences due to religious beliefs, keeping kosher, Catholic residents who are fasting from meat on certain days, etc.

When I was a child we never ate meat on Friday, not just Good Friday but all Fridays. Never on Ash Wednesday. Now, most people refrain from eating meat on Fridays only during lent.

Some old folks still don’t eat meat on Friday year round. My neighbor refuses to eat meat on Fridays.

What about vegetarians or vegans?
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Not really. I mean, this isn't something WE can take up with them.
Are you certain that you are correct?
This would be exceptionally unusual, because as you can imagine it would/could cause diabetic crisis, more staff needs, hospitalizations and absolute chaos.

You have, I am assuming, spoken with the administration?
What do they say to you about this negligent behavior?
It may be time to call an ombudsman.
A facility could literally lose their licensure over such a thing.
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cebswood Nov 11, 2023
Yes, I'm certain. I've been there when they served the meals, and taken pictures of what they served, as well as tried the food and drinks. My mom has a cell phone and has taken pictures and sent them to me, as well. They also would never give the residents there insulin at the correct times so it was less effective. My mom pushed back for months until they finally started doing it correctly. I do need to speak to the administration l. My mom fears harassment from the staff of she complains too much because it's happened several times. She's been yelled at for things completely out of her control. However, she was at a previous facility that was much worse and she is worried if she leaves were she is she could end up someplace like that again. We did speak to the ombudsman about the previous place but we have no idea if anything was done. It certainly didn't improve anything for her.
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Is your mom insulin dependent? On other diabetes medication, such as metFormin? Is she getting routine blood work done to monitor her A1C?

Is she under a doctor/endocrinologist's care for her diabetes? Because if she is, that's where I would start if I were you.

I read your mom is in her 60's with "age related decline"; does that mean she is having cognitive issues? Was her diabetes well under control before she entered the facility?

When you have diabetes, the older you get, the more "leeway" a doctor will give a patient regarding diet. Mostly because hyPOglycemia - low blood sugar - is a much greater risk as you get older than hyPERglycemia - high blood sugar - is, especially if the patient has had good control over their diabetes in the long term. Since most diabetic complications come from ***long-term*** uncontrolled glucose levels, and many older people, especially those with cognitive issues, have a hard time recognizing the symptoms of low blood sugar (which is an immediate medical crisis), the ADA recommends a higher A1C level for elderly diabetic patients, particularly those who have cognitive decline and/or are in facilities such as SNF's.

As long as mom has given her doctors' permission to talk to you, I would call her PCP/endocrinologist first and discuss this with him/her. If need be, arrange for an A1C test to see where mom is, and if those levels are acceptable for mom, her age and her particular health issues.

Not that a sugar-laden, carb heavy diet is particularly healthy for anyone, but it might not be affecting your mom's diabetes as much as you fear it is.

Good luck!
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cebswood Nov 11, 2023
Thank you for your response, btw!
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Yikes! What does the doctor's orders say for your Mom? Is she on a restricted diet that specifically says no sugar, etc?

Is she is a licensed facility?

If she is not in a licensed facility, then you should move her. If she is in a licensed facility and if the administrator is not taking action (make sure you document every interaction you have about this infraction), then contact the licensing board. I'm assuming that you know for a fact that she is getting sugar versus a sugar substitute.

There is a federal program called LTCOP which has ombudsman who might be able to help you. You might see what they are able to do. Each state administers their own program.

Good luck!
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cebswood Nov 11, 2023
Thank you!
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This is horrible! Obviously this will/is negatively improving your mom's health. If your mom's A1C is increasing under their care, then they are being quite negligent and it really should be fixed.

The easiest fix would be on the drinks. Nothing but water and plain coffee or plain hot tea.

Meals - I would think/hope that there are ingredients in their kitchen that could make a diabetic friendly low carb meal. For example, there are often meat, carbs and veggies at most meals. So, ditch the carbs and give her more veggies? I am probably being overly simplistic but seems like something MUST be done. How about sandwiches? Without the bread? My mom's AL offers sandwiches as an option at lunch and dinner so I would have her just get the meat and cheese.

I would be talking to someone there ASAP. This would make me crazy!! So negligent!
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Snfs are regulated by Medicaid and Medicare. The last thing they want is for you to initiate a complaint with the ombudsman over doctor ordered meals.

I would request one last meet with the top cats and say, look, my mom needs to be fed her doctor prescribed diet and there shouldn’t be any reason to escalate things. Hopefully they see what you mean.
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I guarantee your mom is not the only diabetic in there. Contact the adminstrator in charge of the whole place and request a meeting with them, the director of nursing, and the dietician. Make it REALLY clear that it is their job to meet dietary requirements, and you expect your mother to be given the proper diet. Ask to see a week's worth of menus for the diabetic patients, too, to ensure they even have such a menu.

My mother's nursing home gave her soups and other salty items when she was on a low-salt diet and had severe edema. Because she had dementia and was basically blind, she couldn't order from theiI put a sign on her door that said LOW SALT DIET ONLY, and had the meeting I described above, and you'd better believe they cleaned up their act.
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Your Moms care plan should have that she has a special diet and it should be followed. If the Dr orders it, it should be followed. Moms preferences should be honored. This is just why I dread any sort of stay in a facility. I am a picky eater.
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anonymous1732518 Nov 16, 2023
Ah there's the rub. Mom's doctor or the facility doctor.

The facility may be going by their doctor as long as mom is there.
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Definitely speak to your mother’s doctor and then randomly appear at meal times to see what is really being served. I worked in an ASL kitchen when I was 18. They were not serving the menu the dietitian had posted (canned peaches instead of green salad, for example). It was fraudulent. The owners cared about money, not their clients.

As a diabetic now, myself, your mom has my sympathy. Fight this. Is there anywhere else she can be moved? My own mother was in a home facility with six patients and one owner was a registered nurse. They were fantastic. Is that a possible option for you?
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Yeah they did that to me when I was in the hospital. They are clueless or lazy. I just ate the least offensive foods. I told them many times I was diabetic but they ignored me.
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Deb555 Nov 18, 2023
In the hospital (and nursing homes), staff are required to follow the diet that the doctor ordered. Some Doctors use standard orders so everyone goes on the doctor's preferred diet. Next time have the nurse contact the doctor to have the diet changed.
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These nursing homes sometimes just ignore the Doctor's orders and do as they please. When my sister was put into a nursing home they were giving her drugs that were causing her to fall all the time. When I found out she was on them, I called her doctor and him what was going on. He immediately faxed an order to the home and told them to discontinue the drugs.

The nursing home pretended they never got the fax. I went to the doctor's office and had them print out the order and handed it to them. They could not deny receiving it.

But, I wish I could have gotten her out of there completely. They don't care about the people in there. They treat them like trash.

If you can please try to find in home care for her instead. There are programs available to help pay for care if needed.
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my2cents Nov 16, 2023
Sleepy patients are quiet patients. Those in diapers can sit for hours. All sorts of ways to reduce the work load for staff that show up and for those they don't hire because it would cut in to the profit.
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As I read this and just had lunch, one of the drinks was fruit punch which was poured down the drain.

The ironic and sad but comical part, on the slip with the lunch it says "Cold Beverage of Choice". That has not happened here since I've been here, so plain old good water from the nurses station and/or bathroom tap has been the drink of choice.
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Hi Cebswood:
As I said below, it would be VERY unusual for a care facility to do this.
It would mean diabetic crisis which causes not only a lot of chaos and tranferring to hospital, but a certain investigation and a loss of licensure.
I suggested you speak with administration. Omsbudsmen also mentioned.
I am wondering if you can tell us where you are in followup on this post.
Would be so interested to hear.
Hope things are going well.
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anonymous1732518 Nov 16, 2023
@AlvaDeer

How so? If the NH is similar to this facility, they probably have vending machines offering junk food and soda, available to residents and non residents.

The not funny part, pop is $2 and still it just about sells out to name one example
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Be with her at meal time, take a pic of the meals and show them to administrators. The meals don't match her nutritional orders that should be on file. There should be no problem with preparation of food that meets her needs - short handed or not. My guess would be nearly half the folks who live there are diabetic.
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TouchMatters Nov 16, 2023
Everything needs to (also) be in writing.
There needs to be a paper trail.
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It would seem to me that they could be held legally accountable for her health, decline.

Write an official letter to:
The facility administrator.
The Board of Directors.
The director / Head Chef of Food Services/The Dining Room-whoever manages it.

cc: This letter to her doctor.

If you are not local, send it certified mail.
If you are local, hand deliver it.

If they read it when you hand it to them (administrator), ask them to put in writing what they are doing about this and when the changes in her dietary orders will be in effect. Get everything in writing.

Track / journal everything: time, date, who, what transpired.

Concurrently to writing the letter, call her MD and have them call the administrator of the facility.

No matter what happens, do cc their Board of Directors. They need to know about these things. It is inexcusable.

I had to report a nursing home to their / the licensing board.
You can find out who that is (county, state). Make an official complaint.
Work with an Umbudsman, too.

Gena / Touch Matters
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Igloocar Nov 17, 2023
I'd add--and I think you're probably thinking the same--that it would be better to send actual physical letters in writing rather than e-mails. There is a greater permanence about them!
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Can't you fight this legally? Or at least threaten? I'd be in there like a bowl full of fists, none of this makes sense! How can they expect to be paid if they're not remotely doing their jobs??
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cebswood: This is UNACCEPTABLE! Your mother's A1C must have skyrocketed! Go to the top of the facility.
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Ask to meet with the head of dietary staff to discuss her diet and options. If he/she/they can not meet her needs, then discuss this with the administration. You may have to buy her food she can eat, but she shouldn't be charged extra for meals she can not eat.
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Is this a nursing home or an assisted living facility? At my father's assisted living they do not have any specialized dietary services. They have a menu of items and the residents select their meals, like you'd do in a restaurant. There are no specialized low salt (although the food is pretty low salt to begin with) or diabetic menus. They made this clear when he moved in that is not a service they provide. If you need a special diet they suggest you provide for your own meals or move to a different facility.
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elisny Nov 21, 2023
From the description, her mother is in a skilled nursing facility -- i.e. a nursing home.
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My father did a long stay at a SNF/Rehab last year. He’s got CHF, type 2 diabetic, is completely blind with limited hearing & limited mobility. Although his doctors had explicit orders for a specialty diet, the SNF simply ignored it. I documented the food that was given to him as best I could by taking pics & communicated the failures to his doctors who in turn contacted the SNF multiple times. Even after all of it, he was still fed whatever they felt like giving him.

It is a fact that food can be medicine, just as it can also be poison.

When I researched Assisted Living Facilities, MC, & NHs * none * would make any commitment to honor dietary restrictions. I was advised to prepare his meals ahead of time & to bring them & any other foods to the facility. I was absolutely floored by this!

In all honesty, this is the main reason I have not placed my father into a true facility just yet. I know it’s ultimately a death sentence, not for malicious reasons, but just simple circumstance. The nurses at the SNF would give him candy & chips & my dad would just love it up. It’s like they’re pacifying him in exchange for more diuretics & insulin.

Perhaps it’s because my mother was a professional chef & my family was in the restaurant/vending industry for 50 years & I worked at the local destination heath spas, etc. … I’m hyper aware of how eating habits directly affect healthcare outcomes, never mind overall wellbeing. Food is one of the most essential parts of human existence.

I really could go on and on about this particular issue. Food service in institutional settings doesn’t have to be the thoughtless slop it often is, but we all know it’s “profits over people” world.
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anonymous1732518 Nov 19, 2023
This SNF probably had a couple vending machines as well?

At the facility I'm in there are as well as soda and snacks at the front desk ( all for a cost of course).
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Give the administration one last chance, if you feel like there is any chance they will listen. If her doctor can communicate with them, all the better. I suggest you reference . . .

42 CFR § 483.60 Food and nutrition services.
"The facility must provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs, taking into consideration the preferences of each resident."

https://www.law.cornell.edu/cfr/text/42/483.60

~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~
If you have gotten nowhere, or get nowhere:
1.
First contact the state's long-term-care ombudsman's office and get them working on it. You can locate the information here: https://theconsumervoice.org/get_help

If you are in IN, as it appears: https://theconsumervoice.org/get_help/state_resources/in

The ombudsman don't have a lot of teeth, but their communication will effectively put the facility on notice that you are taking action to get this addressed.

2.
If it doesn't get resolved, move to the next step, which is to file a complaint with the state agency that oversees the regulation of nursing homes. It looks like you are in Indiana. If so, here is where you can file a complaint:
https://www.in.gov/health/ltc/contact/complaints/

~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~
Take note that when I filed a complaint in Florida after a demented and sometimes violent resident repeatedly tried to get into my mother's room, the arrogant "high end" (read: Hyatt / Pritzker spawned devil-child) facility illegally banned me from the property and it took hiring an attorney and waiting 2 months to get before a judge who ordered, "immediate access!!!" The facility ended up coughing up the money for our legal costs, but it was a traumatic 2 months for my mother and myself. The agency (AHCA) finally cited the facility for violating my mother's federal and state rights, but the 2 months were gone.

*** The whole system stinks and is really a fraud against elders and their families. And I repeatedly advise people to do whatever they can to stay out of long-term-care facilities for as long as humanly possible.

*** After this incident, I learned the law: https://www.law.cornell.edu/cfr/text/42/part-483/subpart-B .
In addition, the facility had been put on notice that it is illegal to interfere with complaints. I filed many, many more - all deserved.
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