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Dietary Service - Dining Experience

Description of Federal Requirements
Comparison of State Requirements
Table Comparing States

Complete Transcript of State Requirements on Dining Experience (PDF)


Federal Regulations & Related F-tags Applicable Federal Regulation
(1-4) Food | F364-F366

  • 483.35 Dietary Services
  • 483.15 Quality of Life
  • Description of Federal Requirements    (TOP)    (NEXT)

    The Federal regulations are rather silent on the dining experience, especially on where a resident may dine. They do address food by stating that food must be prepared by methods that conserve nutritive value, flavor, and appearance and be palatable, attractive, and at the proper temperature (F-364-F-365, and F-366).

    Comparison of State Requirements    (TOP)    (NEXT)

    Some states go beyond the Federal regulations and require extra amenities to improve the experience of dining. Massachusetts requires that food shall be served in a home-like, pleasant, clean, relaxing and quiet atmosphere. In South Carolina, the dining area shall provide a congenial and relaxed atmosphere. In South Dakota, the dietetic service must meet the social needs of the residents in the dining setting. Social needs include mutually compatible seating arrangements, pleasant dining atmosphere and encouragement of interactions between residents. Washington requires sufficient time be allowed for eating in a relaxed manner.

    New Jersey has a section on advisory resident dietary services that if enacted, would provide an enriched dining experience for the residents. Advisory services include: dietary observances for national and/or religious holidays; fresh fruits and vegetables are served in season on a daily basis; the facility utilizes a dining room/area, other than day rooms, for residents with special needs; residents have access to a refrigerator or snack bar; residents are offered a selective menu consisting of at least three main entrees at each meal; a menu committee composed of residents participates in meal planning; the facility sponsors a guest meal program and the facility provides cloth table covers and cloth napkins at least once a day.

    In Ohio, a nursing home may provide home-style meals or buffet service if the residents agree to participate in the meal service and the home uses precautions to prevent contamination of food being served and assists resident when necessary. Home-style meal service means a dining experience where small groups of residents sit together for a meal and each resident portions his or her own food onto his or her plate from a serving platter or bowl. The serving platter or bowl is then passed to another resident in the group. Buffet service means an informal meal service that is set up in a manner that allows residents to portion their own food onto their plates from a buffet of food items and transports to a table in the dining area for consumption.

    Arizona requires that a resident eats meals in a dining area unless the resident chooses to eat in the resident’s room or is confined to the resident’s room for medical reasons documented in the medical records. Minnesota specifies that meals are to be served in a specified dining area consistent with the resident’s choice and plan of care. In Connecticut, all patients shall be encouraged to eat in the dining room unless medically contraindicated while Delaware encourages patients to eat in the dining room even if a wheelchair is needed. Maine requires that all residents seated at the same table shall be served at the same time while South Dakota requires food service to all residents at a table at approximately the same time.  In Nevada, a resident must not be served meals in his bedroom for more than 14 consecutive days if he is temporarily unable to eat in the ding room because of an injury or illness. A record of the times and reasons for serving meals to the resident in his room shall be maintained. New Mexico specifies that table service be provided for all who can and will eat at a table.

    Several states have regulations that seem to prohibit utilizing the universal worker, household model or Green House concept. In Mississippi, tables should be of a type to seat not more than four (4) or six (6) residents. Personnel eating meals or snacks on the premises shall be provided facilities separate from and outside of food preparation, tray service, and dishwashing areas.  [NH Regs Plus Comment: These regulations are contrary to the Green House model where a large table that seats 12 residents and staff is the centerpiece of the dining area.]

    In Arkansas, the public, personnel, or patients shall not be permitted to eat or drink in the kitchen, dishwashing area, or store room; only dietetic services and administrative personnel shall be allowed in the kitchen; only dietetic services personnel shall be allowed to portion out food for patients or personnel; and nursing home residents will not be permitted to work in the dietetic services. If a patient is to be allowed to scrape trays, there must be a physician’s order. [NH Regs Plus Comment: One of the ideals of the Green House model is that the elders work alongside staff in the kitchen and this regulation would forbid that practice.]

    Also, trays shall not be set up until the meal is ready to be served and food shall not be at the patient’s place in the dining room until the patient is at the table.  [NH Regs Plus Comment: This is contradictory to the practice of residents arriving at their dining place and leisurely starting the meal with a salad or coffee that is waiting for them.]

    Arkansas addresses table coverings and dishes by requiring that table covers used in the dining room shall be of a fabric which can be laundered and they shall be kept clean and changed at least daily. Dishes, silverware, and glasses shall be free of breaks, tarnish, stain, cracks and chips and there shall be an ample supply to serve all patients. Patients will be furnished knives, forks, and spoons unless there is documentation to indicate the patient is incapable of using these implements. Hawaii requires food to be served with the appropriate utensils. Illinois requires that each facility provide an adequate number of dishes, glassware, and silverware of a satisfactory type to serve all residents in the facility at each meal. Iowa requires that table service be attractive and that plastic ware, china and glassware that are unsightly, unsanitary or hazardous because of chip, cracks or loss or glaze shall be discarded. Maine requires that food shall be served on dishes and shall not be in direct contact with trays. Minnesota requires that only dishes and utensils with the original smooth finishes may be used. Cracked, chipped, scratched, or permanently stained dishes, cups, or glasses or damaged, corroded, or open seamed utensils or cookware must not be used. Dishes or plate settings must not be set out on the tables more than two hours before serving time. In Rhode Island, food shall be attractively served on dinnerware of good quality, such as ceramic, plastic or other materials that are durable and aesthetically pleasing.

    Massachusetts regulates the use of disposable dishes with the following regulations: single service disposable dishes, cups or cutlery shall not be used except as follows: 1) on a regular basis: only for between meal food services; in the preparation of individual services of gelatin desserts, salads and puddings, in serving juice, jellies and other condiments. 2) On a temporary basis: for individual with an infection illness, or when kitchen areas are being remodeled, providing that prior approval for use of a specified period of time has been received from the Department. 3) disposable single service items shall comply with the following: dishes shall be made of non-absorbent materials; items shall be rigid and sturdy; items shall be coordinated according to color and design and be aesthetically appealing, flatware shall be full sized and heavy weight; items shall be used only once and then discarded; and all items shall be stored according to manufacturer’s instruction and handled and dispensed in a sanitary manner. In New Jersey, disposable dishes and cutlery may be used for special meal activities or individual resident needs.

    Table Comparing States        (TOP)

    Note: If the States in this table are not hyper-linked, their provisions do not appear to address the topic, and therefore, do not alter the Federal Regulatory scope.  The Table summarizes content on Dining Experience by State (with a link to each State's specific language).  Link to a downloadable PDF document containing all State requirements on Dining Experience.

    483.35 Dietary Services

    Dining Experience
    State Goes beyond Federal Regulations? Subjects Addressed: How State Differs From or Expands On Federal Regulations
    Alabama Yes Same as Federal Categories.
    Alaska No Alaska regulations do not contain specific content for Dining Experience.
    Arizona Yes Resident dining location.
    Arkansas Yes Table covers; dishes and glass condition; patients not allowed to scrape dishes; trays not set up until meal is served; no food on table previous to resident arrival.
    California Yes Table service for those who can and wish to eat at table.
    Colorado Yes Dining space consistent with resident comfort & safety.
    Connecticut Yes Patients encourage to eat in dining room.
    Delaware Yes Dining room large enough to accommodate all patients.
    District of Columbia Yes Furnish 1 or more rooms to be well ventilated with designated smoking area.
    Florida No Florida regulations do not contain specific content for Dining Experience.
    Georgia No Georgia regulations do not contain specific content for Dining Experience.
    Hawaii Yes Food served with appropriate utensils.
    Idaho Yes Tray service to be attractive.
    Illinois Yes All residents served in dining room except for valid reason.
    Indiana No Indiana regulations do not contain specific content for Dining Experience.
    Iowa Yes Table service shall be attractive: dishes in good condition.
    Kansas Yes Facility shall providing dining room service for all capable residents.
    Kentucky No Kentucky regulations do not contain specific content for Dining Experience.
    Louisiana Yes Kitchen not used for dining of residents.
    Maine Yes All residents seated at the same table shall be served at same time.
    Maryland No Maryland regulations do not contain specific content for Dining Experience.
    Massachusetts Yes Home-like, pleasant, clean, relaxing and quiet atmosphere; washable or disposable tray mat; disposable dishes.
    Michigan No Michigan regulations do not contain specific content for Dining Experience.
    Minnesota Yes Dishes or plate settings not set on tables more than 2 hours before serving time; condition of dishes; dining area consistent with resident's choice.
    Mississippi Yes Table should seat not more than 4 or 6 residents; no TV trays.
    Missouri Yes Attractive dining room service.
    Montana No Montana regulations do not contain specific content for Dining Experience.
    Nebraska Yes Dining area requirements including electrical system for illumination.
    Nevada Yes Room service; resident not served in bedroom for more than 14 consecutive days.
    New Hampshire Yes Dining facilities segregated by walls or partition.
    New Jersey Yes Advisory resident dietary services; non-disposable dishes; cloth table covers and napkins at least once a day.
    New Mexico Yes Table service.
    New York No New York regulations do not contain specific content for Dining Experience.
    North Carolina No North Carolina regulations do not contain specific content for Dining Experience.
    North Dakota Yes Table service.
    Ohio Yes Home-style meal and buffet service defined.
    Oklahoma Yes Facilities provided to support food service system selected.
    Oregon Yes System to maintain resident receives appropriate diet.
    Pennsylvania Yes Tables and space to accommodate wheelchairs with trays.
    Rhode Island Yes Dining room for group dining; good quality dishes.
    South Carolina Yes Congenial and relaxed atmosphere.
    South Dakota Yes Social needs; dining arrangement.
    Tennessee No Tennessee regulations do not contain specific content for Dining Experience.
    Texas Yes Efficient, sanitary, and pleasant environment
    Utah No Utah regulations do not contain specific content for Dining Experience.
    Vermont Yes Same as Federal Categories
    Virginia Yes Disposable dinnerware; dish quantity
    Washington Yes Food served in attractive manner and at temperatures acceptable to each resident
    West Virginia Yes Attractive food
    Wisconsin Yes Table service for all residents who can and want to eat in dining room
    Wyoming No Wyoming regulations do not contain specific content for Dining Experience.

    Complete Transcript of State Requirements on Dining Experience    (TOP)