Feeding Assistant Training

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Feeding Assistant Training

• Linda Montgomery, RN, BSN
• Brenham High School
• HSTE PDC, 2006

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Health Science Technology Education

• The coherent sequence in HSTE includes courses
  that provide students knowledge and skills to
  pursue a career through continued academic
  preparation and/or entry level employment.

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Entry Level Employment through HST
Certified Nurse Aide
Emergency Medical Technician
Phlebotomist
Pharmacy Technician
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And Now

• Feeding Assistant in Long-Term Care

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Why have feeding assistants?

• Primary Goal is for residents to receive more
  assistance with eating and drinking to help
  reduce the incidence of unplanned weight loss and
  dehydration.
• Dehydration-a fluid imbalance caused by too
  little fluid taken in or too much fluid lost or
  both-can occur quickly in all older adults, and
  the effects can be harmful. (AJN, June, 2006)

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Age Related Changes That Promote Dehydration

• Thirst response becomes blunted with age and is
  bodys primary mechanism of signaling need for
  fluid.
• Total body fluid decreases after age 60.
• Kidney function declines and kidneys less able to
  concentrate urine.
• Many avoid fluids for fear of incontinence.

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Risk Factors for Dehydration

• Medications that directly affect renal function
  and interfere with fluid balance
• Inability to perform ADL
• Cognitive impairment-people with dementia often
  forget to drink.
• Concomitant conditions such as frailty, diabetes,
  cancer, cardiac disease, acute infections

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Potential Consequences of Dehydration

• Constipation
• Falls
• Medication toxicity
• Urinary tract respiratory tract infections
• Delirium
• Renal failure
• Seizure

• Electrolyte imbalance
• Hyperthermia
• Longer time to wound healing
• Emergency hospitalization
• Increased mortality
• (AJN, June 2006)

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Factors for Resident Malnourishment in LTC

• LTC facilities are usually short-staffed with
  many residents to feed or assist.
• Residents feel rushed and do not eat enough.
• Lack of personal attention-residents may feel
  lonely, bored, or depressed-affects intake of
  food and drink.
• Need less calories but same amount of vitamins,
  minerals, protein.
• Some protein rich foods may be hard to chew or
  digest

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• Because of these factors and because many more
  residents need assistance with eating and
  drinking, the federal government created a new
  regulation in 2003. This regulation allows state
  to hire and train paid feeding assistants to work
  in LTC facilities.

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Paid Feeding Assistants in Texas

• Feeding assistants must be trained using the
  state-approved TX DADS training course.
• Sixteen hour course of which three hours are
  spent observing student feed resident at two to
  three meals
• A licensed nurse will evaluate the feedings and
  students readiness to feed residents based on
  these feedings.

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Texas Department of Aging and Disability Services
(DADS)

• Formerly Texas Department of Human
• Services
• Training guidelines for feeding assistants
• available online at www.dads.state.tx.us/business
  /ltcr/
• credentialing/curriculum/index.html
• TX Program developed in 2004

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Supervision of Feeding Assistants

• Nursing facilities may utilize paid feeding
  assistants to provide assistance to residents
  during feeding times (meals, snacks)
• Must work under the supervision of a RN or LVN.
• In an emergency, must call supervisory nurse for
  help
• Can only feed residents in the dining room

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Resident selection criteria

• Can only feed residents who have no complicated
  feeding problems, which include difficulty
  swallowing, recurrent lung aspirations, and tube
  or parenteral feedings.
• Resident selection based on charge nurses
  assessment and the residents latest assessment
  and plan of care.

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Training for Feeding Assistant

• Divided into 10 modules
• Each module contains topic specific information
  and review space to be used for identifying your
  facilitys approaches for topic discussed
• Can add review questions of own
• Can add other studies from other references
  (Example-Assisting with Nutrition and Hydration
  in Long-Term Care, Hartman Publishing)

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Module 1 Mealtime Enjoyment

• Your attitude toward the residents can directly
  affect how they eat.

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Module 2

• Nutrition
• Hydration
• And Therapeutic diets

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Module 2 covers

• Nutritional and Fluid Needs
• Dehydration
• Nutrition and Weight Loss
• Nutrition and Pressure Ulcers
• Therapeutic Diets
• Swallowing, Dysphagia, and Aspiration

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Module 3-Communication and Interpersonal Skills

• Effective communication can improve your
  relationships with residents, make your job
  easier and save time.
• Positive communication may improve residents
  response to you resulting in improved meal
  intake!

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Module 3 covers

• Definition of communication
• Changes in aging that affect communication
• Importance of good communication
• Techniques of effective communication
• Communication during meals
• Appropriate and inappropriate topics for
  discussion with residents
• Talking to visitors

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• Role-Play communicating with residents who have
  vision loss, hearing loss, problems with
  speaking, and/or problems with understanding

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Module 4-Resident Rights

• Residents do not give up any rights when they
  enter a nursing facility!
• The facility and its staff must encourage
  assist residents to fully exercise their rights.

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Module 4 covers

• Resident rights
• Respecting and promoting resident rights and
  independence
• Promoting resident privacy
• Definitions of abuse, neglect, and
  misappropriation
• Guidelines for avoiding abuse, neglect, and/or
  misappropriation of resident property
• Facility procedures

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Module 5-Infection Control Food Safety

• Infection Control method used in health care
  facilities to prevent spread of pathogens or germs

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Module 5 covers

• Definitions
• How infections are spread
• Food safety
• How to prevent infection, foodborne illness
• Handwashing
• Serving food safely

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HANDWASHING

• Is the Single
• Most Important Thing
• You Can Do to
• Prevent Infection
• And Foodborne Illness!!

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Module 6 Feeding the Resident

• You should care for residents as you would care
  for yourself or for your loved ones!
• You MUST make sure the right resident gets the
  right tray with the right food!

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Module 6 covers

• Preparing the dining area
• Preparing resident prior to meals
• Serving trays
• Guidelines for assisting residents
• Guidelines for feeding residents
• Eating problems you must report
• Adaptive devices (show examples)
• Restorative dining defined
• Feeding problems and interventions

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Module 7-Appropriate Responses to Resident
Behaviors
Occasionally older adults may display behaviors
that are considered socially unacceptable
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Module 7 covers

• Normal behaviors
• Behavioral problems considerations for care
• Causes of behaviors
• Difficult behaviors suggestions for responding
• Reporting difficult behaviors

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Module 8-Safety and Emergency Procedures
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Module 8 covers

• General safety
• Potential hazards
• Situations which call for emergency action
• Your role in emergency procedures
• Emergency measures for power outages, fire,
  falls, choking, seizures, wandering or lost
  residents, finding an unresponsive resident,
  severe weather

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Module 9-Practicum

• Observation of student feeding resident for at
  least two meals, maybe three.
• Time should equal at least three hours and must
  be documented.
• Classroom time should also be documented.

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Observation of feedings

• Skills evaluated must include, but are not
  limited to the following
• Handwashing
• Feeding a Resident
• Serving Trays (must be completed correctly to
  pass) Feeding assistant must check for
• Correct resident
• Correct eating and adaptive equipment
• Correct diet
• Correct fluids

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Module 10-Instructors Evaluation Discussion

• Instructor and feeding assistant will review and
  discuss observations and evaluation of the
  feeding.
• Correct completion of activities or questions at
  end of each module
• Written exam over state guidelines (not required
  by state but developed by me)

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Conclusion

• Send letter to facility documenting
• Date and location of the course
• Name of the trainer
• Statement that the course was successfully
  completed with at least 13 hours of class time
  and 3 hours of observation of feeding residents
• Send copy of letter to student for his/her files
• Keep copy of letter for your files

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• Facility must maintain a record of all
  individuals used by the facility as paid feeding
  assistants who have successfully completed the
  state-approved training course.
• If paid feeding assistants seek employment at
  another facility, will not be required to repeat
  course with letter of documentation.

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• Even though there is no official state
  certification for feeding assistant, your Career
  Technology Director can report these students
  to TEA because they are now prepared for and have
  the skills for entry level employment. At this
  time, there is no blank for feeding assistant
  place their number under other. In the future,
  they should be included.

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Sources

• Feeding Assistant Training Manual, Texas
  Department of Aging and Disability Services,
  June, 2004 www.dads.state.tx.us/business/ltcr/cre
  dentialing/curriculum/index.html
• Mentes, Janet. Oral Hydration in Older Adults,
  AJN, June, 2006, pp.40-48
• Assisting with Nutrition and Hydration in
  Long-Term Care. Hartman Publishing, Inc.2004

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Resource Person at DADS

• Tina Festi
• 512-438-2275