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Dietary Services - Frequency of Meals

Description of Federal Requirements
Comparison of State Requirements
Table Comparing States
Complete Transcript of State Requirements on Frequency of Meals (PDF)

Federal Regulations & Related F-tags Applicable Federal Regulation
(f) Frequency of meals | F368

  • 483.35 Dietary Services
  • Subpart D - Requirements That Must be Met by States and State Agencies: Nurse Aide Training and Competency Evaluation, and Paid Feeding Assistants
  • Description of Federal Requirements    (TOP)    (NEXT)

    Under Federal regulations, each resident receives and the facility provides at least three meals daily, at regular times comparable to normal mealtimes in the community. There must be no more than 14 hours between a substantial evening meal and breakfast the following day, except when a nourishing snack is provided at bedtime, up to 16 hours may elapse between a substantial evening meal and breakfast the following day if a resident group agrees to this meal span, and a nourishing snack is served. The facility must offer snacks at bedtime daily (F-368).

    Comparison of State Requirements    (TOP)    (NEXT)

    Generally the state regulations follow the Federal regulations as far as the interval between the evening meal and breakfast. Some states specify the time span between the meals and some states have added information on what a nourishing snack should consist of. In Arizona, an evening snack includes meat, fish, eggs, cheese, or other protein, and a serving from either the fruit and vegetable food group or the bread and cereal food group. In Idaho, if the “Four or Five –Meal-A-Day” plan is in effect, meals and snacks shall provide nutritional value equivalent to the daily food requirements and the last meal (snack) shall provide at least one ounce of a protein food exclusive of beverage served. In Oregon, snacks of nourishing quality are those which provide substantive nutrients in addition to carbohydrates and calories, e.g., milk and milk drinks and fruit juice. Tennessee requires a “supplemental night meal” be served if more than 14 hours lapse between supper and breakfast. In Indiana, a nourishing snack is an offering of a minimum of a food item and a beverage while in Hawaii, between meal nourishments consistent with need shall be offered routinely to all patients. In Louisiana, a nourishing snack is defined as a “verbal offering” of items, single or in combination, from the basic food groups. In Maine, a nourishing snack is defined as an “offering of items”, single or in combination, from the basic food groups and adequacy of the nourishing snack will be determined both by resident interviews and by evaluation of the overall nutritional status of resident in the facility (e.g., Is the offered snack usually satisfying?). In Minnesota, the nursing home must offer evening snacks daily. “Offer” means having snacks available and making the resident aware of that availability. In Arkansas, there shall not be more than fourteen hours between a substantial supper and breakfast. Supper shall include as a minimum: two ounces of a substantial protein food, a starch (or substitute) or soup, vegetable or fruit, dessert and beverage, preferably milk. Bedtime snack consisting of milk, juice, cookies, or crackers shall be offered. In Illinois, the 14 hour span shall not apply to facilities using the “four or five meal-a-day” plan, provided the evening meal is substantial and includes, but is not limited to, a good quality protein, bread or bread substitute, butter or margarine, a dessert and a nourishing beverage. Missouri requires at least three substantial meals per day, of which at least two are hot. In Nevada, facilities must serve at least three meals “or their equivalent” daily, at regular times. A second serving must be provided for those clients who desire one.

    Texas and West Virginia address documenting resident snacks in records. Texas specifies that routine snacks that are not ordered by the physician and are not part of the plan of care do not need to be documented as accepted or rejected while West Virginia specifies the amount of the snacks consumed by the resident shall be recorded in the residents’ medical record.

    Several states address designated times for serving meals while other states require nursing homes to accommodate individual mealtime preferences. In Arkansas, there shall be at least a five (5) hour span between breakfast and the noon meal and between noon meal and supper. The meals shall be served at approximately the same hours each day. In New Mexico, three meals shall be offered to each resident daily, not more than six (6) hours apart. In Ohio, there shall be at least a four (4) hour interval of time between the breakfast and noon meal and between the noon and evening meal.  Ohio also requires the nursing home to “accommodate a resident’s preference” or medical need to eat at different intervals. Washington requires the nursing home to accommodate individual mealtime preferences and portion sizes, as well as preferences for between meal and evening snacks when not medically contraindicated and that the nursing home offer a late breakfast or an alternative to the regular breakfast for late risers. In Colorado, routine seating shall be no later than 8 A.M. for breakfast and no earlier than 5 P.M. for the evening meal. Timing of meals shall generally comport with cultural practices in the community, unless inconsistent with regulations. In Illinois, snacks of nourishing quality shall be offered between meals when there is a time span of four or more hours between the ending of one meal and the serving of the next. In Massachusetts, meals shall be served at regular times, with not more than a “15 hour” span between a substantial evening meal and breakfast. Breakfast shall not be served before 7:00a.m; the evening meal shall not be served before 5:00p.m. When a four or five-meal-a-day plan is in effect, the main evening meal shall not be served before 4:00 p.m. In Wisconsin, meals shall not be more than 6 hours apart with not more than a 15-hour span between a substantial evening meal and breakfast. In New Jersey, the first meal shall not be served before 7:00 A.M. unless requested by the resident. In Rhode Island, breakfast shall not be served before 7:00 a.m. nor later than 8:30 a.m. Lunch shall not be served before 11:00 a.m. nor later than 1:00 p.m. Supper shall not be served before 5:00 p.m. nor later than 6:00 p.m.

    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 Administration by State (with a link to each State's specific language).  Link to a downloadable PDF document containing all State requirements on Frequency of Meals.

    483.35 Dietary Services

    Frequency of Meals
    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 Frequency of Meals
    Arizona Yes Time between meals; snack items
    Arkansas Yes Time between meals; supper items; snack items
    California Yes Time between meals; between-meal feeding; bedtime nourishments
    Colorado Yes Time between meals; breakfast hour; evening meal hour; cultural practices
    Connecticut Yes Time between meals; bedtime nourishments
    Delaware No Delaware regulations do not contain specific content for Frequency of Meals
    District of Columbia No District of Columbia regulations do not contain specific content for Frequency of Meals
    Florida No Florida regulations do not contain specific content for Frequency of Meals
    Georgia Yes Hours between meals
    Hawaii Yes Time span between meals
    Idaho Yes Time span between meals; four or five-meal-a-day plan
    Illinois Yes Four or five meal-a-day plan; bedtime snacks; time span between meals
    Indiana Yes Time between meals; nourishing snack requirements
    Iowa Yes Time between meals; nourishing snack requirements
    Kansas Yes Time span between meals
    Kentucky Yes Same as Federal Categories
    Louisiana Yes Time span between meals; bedtime nourishments
    Maine Yes Schedule meal time to normal meal times in community; definition of nourishing snack; adequacy of nourishing snack
    Maryland Yes Substantial evening meal requirements; four or five-meal-a-day-plan
    Massachusetts Yes Time requirements for breakfast and evening meal; three, four or five-meal-a-day plan
    Michigan Yes Nutritional needs of patients.
    Minnesota Yes Substantial evening meal requirements; time between meals; snack offer definition
    Mississippi Yes Timing of meals; snack requirement
    Missouri Yes Three meals per day with at least 2 being hot
    Montana No Montana regulations do not contain specific content for Frequency of Meals
    Nebraska Yes Time span between meals
    Nevada Yes Frequency of meals; regular frequency of meals; second serving of food if desired
    New Hampshire Yes Meal times determined after consultation with residents
    New Jersey Yes Meal times; time span; between meal snacks, bedtime nourishment; and beverages available at all times
    New Mexico Yes Time span for meals; snacks; water availability
    New York Yes Time span between meals; number of meals
    North Carolina Yes Hour of sleep nourishment; between meals fluids; time span
    North Dakota Yes Time span between meals
    Ohio Yes Accommodate resident's preference to eat at different intervals; snack items; intervals between breakfast, noon meal, and evening meal
    Oklahoma Yes At least 4 hours between each meal
    Oregon Yes Time span, substantial evening meal guidelines, snack guidelines
    Pennsylvania No Pennsylvania regulations do not contain specific content for Frequency of Meals
    Rhode Island Yes Explicit time frame when all meals should be served
    South Carolina Yes Time span between meals
    South Dakota Yes Time span between meals
    Tennessee Yes Supplemental night meal
    Texas Yes Snack does not need to be documented if not part of plan of care; meals served at regular times comparable to normal mealtimes in community
    Utah Yes Interval between meals
    Vermont Yes Midday and bedtime snacks; time span between meals
    Virginia Yes At least 3 meals at regular intervals
    Washington Yes Accommodate individual mealtime preferences; offer late breakfast or alternative to regular breakfast for late risers
    West Virginia Yes Snacks shall be recorded in resident records; breakfast not served before 7:00 am unless by a resident's request
    Wisconsin Yes Meal intervals of not more than 6 hours; 15 hour span between evening meal and breakfast; snacks
    Wyoming No Wyoming regulations do not contain specific content for Frequency of Meals

    Complete Transcript of State Requirements on Frequency of Meals    (TOP)