|Description of Federal Requirements|
|Comparison of State Requirements|
|Table Comparing States|
|Complete Transcript of State Requirements on Menus and Therapeutic Diets(PDF)
|Federal Regulations & Related F-tags for 483.40||Applicable Federal Regulation|
(c) Menus and nutritional adequacy. Menus must –
(1) Meet the nutritional needs of residents in accordance with the recommended dietary allowances of the Food and Nutrition Board of the National Research Council, National Academy of Sciences;
(2) Be prepared in advance; and
(3) Be followed.
(d) Food. Each resident receives and the facility provides-
(1) Food prepared by methods that conserve nutritive value, flavor, and appearance;
(2) Food that is palatable, attractive, and at the proper temperature;
(3) Food prepared in a form designed to meet individual needs; and
(4) Substitutes offered of similar nutritive value to residents who refuse food served.
(e) Therapeutic diets. Therapeutic diets must be prescribed by the attending physician.
NOTE: The examples below may not list all States with similar language; always check your state for specifics.
Most states follow the Federal regulations very closely without getting very creative in their dietary requirements. Two states address specific topics not included in the Federal regulations. In Massachusetts, all facilities shall plan and post a Disaster Feeding Plan and staff shall be familiar with it. This plan shall include alternate methods and procedures to be used when equipment is not operable, including proper sanitation of dishes and utensils. In West Virginia, recognizing that the residents has the right to refuse medical treatment, all residents have the right to request substitute foods even when this violates the physician’s orders. A nursing home shall provide education to the resident regarding the benefits of the prescribed diet and consequences of his or her refusal to eat the prescribed diet. A nursing home shall document the informed decision in the resident’s clinical record. Most states address the topics of profile cards, menus, residents diets, and therapeutic diets although in somewhat different ways.
Profile Cards [TOP] (TOP) (NEXT)
In Alaska, a current profile card for each patient indicated prescribed diet, likes and dislikes, and other pertinent information concerning patient’s dietary needs must be maintained. In Arkansas, there shall be a system of patient identification for each tray served which includes the following information: resident’s name, diet; room number; beverage preference; any allergies; and any major dislikes for which there should be a substitution.
In Alaska, a copy of the menus, with menu substations, must be retained for at least 60 days. In Arizona, a food menu is prepared at least one week in advance, conspicuously posted, and adhered to unless an uncontrollable situation requires food substitution such as food spoilage or non-delivery of specific food ordered. In Arkansas, menus shall be planned and written 2 weeks in advance and posted at least 1 week in advance. Menus for each level shall be written. Arrows, etc., are not acceptable. Weekly menus shall not be repeated more often than once every 3 weeks. Menus which have been posted in the kitchen shall not be re-dated and reused. Meals served shall correspond essentially with the posted menus and shall be served in sequential order as planned. Records of menus as served shall be maintained for 30 days. In California, menus shall be written at least 1 week in advance, dated and posted in the kitchen. If any meal served varies from the planned menu, the change and the reason for the change shall be noted in writing on the posted menu in the kitchen. Menus shall be varied for the same day of consecutive weeks. If a cycle menu is used, the cycle shall be of no less than 3 weeks duration and shall be revised quarterly. Menus shall be adjusted to include seasonal commodities; planned with consideration of cultural background and food habits of patients; and kept on file for at least 30 days. In Connecticut, menus shall be planned at least 7 days in advance. In Hawaii, menu cycle shall cover a minimum of 4 weeks and maintained for 3 months.
In Indiana, the regular menu for the facility must be posted or made available to the residents. In Maryland, the basic menu shall be posted in one or more easily accessible places in the dietetic service department and in the patient area. In Nebraska, menus shall be designed to be compatible with the food preferences of the majority of the residents of the facility. In Nevada, menus must be kept on file for 90 days while in Ohio, the “meal records” shall be kept on file in the nursing home for at least one year after being served.
In Arizona, a resident is provided: a diet that meets the resident’s nutritional needs as specified in the comprehensive assessment and care plan; food substitutions of similar nutritional value if resident refused to eat the food served or the resident requests a substitution. In Arkansas, facilities are permitted to serve commodity foods provided that the facility is registered as a non-profit organization and the foods were legally obtained directly from USDA sources. In Colorado, the facility shall reasonably accommodate individual resident preferences in meals by offering appropriate and nutritionally adequate substitutes.
In Georgia, a nutritionally adequate diet shall be provided all patients and adjusted to patient’s age, sex, activity and physical condition. Nutrient concentrates and supplements shall be given only on written order of a physician. Illinois includes an extensive list of required foods, serving size and substitutions. In Louisiana, when the kitchen is not open at all times, a nourishment station shall be provided and supplied. In Massachusetts, appropriate special menus shall be planned for holidays and birthdays. In Minnesota, there must be adjustment to the food habits, customs, likes, and appetites of residents including condiments, seasonings, and salad dressings. There must be resident involvement in menu planning. In New Hampshire, the evening meal shall be no less than 20%of the day’s total nutritional requirements. In Ohio, notification of any significant unplanned or undesired weight change shall be made to the resident’s attending physician and the dietician. Significant unplanned or undesired weight change means a 5% weight gain or loss over a one month period, a 7 ½ % or more weight gain or loss over a 3 month period or a 10% or more weight gain or loss over a 6 month period. In South Carolina, efforts shall be made to accommodate religious practices. Washington requires the facility make fresh fruits and vegetables in season available to residents on a daily basis. Washington must make reasonable efforts to: accommodate individual mealtime preferences and portion sizes, as well as preferences for between meal and evening snacks when not medically contraindicated; offer a late breakfast or an alternative to the regular breakfast for late risers; and provide food consistent with the cultural and religious needs of the residents.
In Arkansas, diet orders shall be reviewed by physician every 120 days for intermediate and minimum care patient and every 60 days for skilled care patients. In California, all regular and therapeutic diets shall be prescribed by a person lawfully authorized to give such an order. Verbal orders may be received and recorded by a dietitian and shall be signed by the prescriber within 5 days. In Idaho, to the extent possible, therapeutic diets shall be planned from the regular menu. In Illinois, a therapeutic diet means a diet ordered by the physician as part of a treatment for a disease or clinical condition, to eliminate or decrease certain substances in the diet (e.g., sodium) or to increase certain substances in the diet (e.g., potassium), or to provide food in a form that the resident is able to eat. All liquid diets shall be reviewed every 48 hours, soft diets every 3 weeks and others as needed or at least every 3 months. Washington addresses tube feeding by requiring: if the nursing home prepares tube feeding formula, or mixes additives to the prepared formula it must ensure that: each resident’s tube feeds are of uniform consistency and quality; and tube feeding formulas are prepared, stored, distributed, and served in such a manner so as to maintain uniformity and to prevent contamination.
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 Menus and Therapeutic Diets.
|State||Goes beyond Federal Regulations?||Subjects Addressed: How State Differs From or Expands On Federal Regulations|
|Alabama||Yes||Same as Federal Categories|
|Alaska||Yes||Current profile card, retain menu at least 60 days|
|Arizona||Yes||Food substitutions; nutrition specifics; menu posting|
|Arkansas||Yes||Minimum daily food requirements; menus; diet orders|
|California||Yes||Menu details; therapeutic diet manual; menu cycle|
|Colorado||Yes||Diet manual; menus; nutritional assessment; orders; meet requirements of 2005 Dietary Guidelines|
|Connecticut||Yes||Menus; diet manual; menu consider menu for food habits|
|Delaware||Yes||Special diets; posting of menu; diet manual|
|District of Columbia||Yes||Meals to include fresh fruits and vegetables in season, appropriate substitutions available|
|Florida||Yes||Meet standards of accepted standards of proper nutrition|
|Hawaii||Yes||Diet manual; therapeutic diets; nutritional assessment; menu|
|Idaho||Yes||General food requirements; menus; therapeutic diets|
|Illinois||Yes||Diet manual; therapeutic diets; diet orders; extensive list of required food items and serving size|
|Indiana||Yes||Nutrition specifics; posting of menu; liquid diet|
|Iowa||Yes||Diet manual; nutrition requirements; tested recipes; therapeutic diets|
|Kansas||Yes||Menus; therapeutic diet|
|Kentucky||Yes||Same as Federal Categories|
|Louisiana||Yes||Diet manual; menu; portion sizes|
|Maine||Yes||Menus; list of food requirements; therapeutic diets|
|Maryland||Yes||Diet manual; menus; retention of records; therapeutic diets|
|Massachusetts||Yes||Diet manual; nutrition specifics; menu planning; special menus for holidays and birthdays|
|Michigan||Yes||Nutritional needs of patients; menus; meal census; food acceptance record|
|Minnesota||Yes||Nutritional assessment; menus; food habits & customs|
|Mississippi||Yes||Diet manual; nutrition specifics; modified diets; meal planning guidelines|
|Missouri||Yes||Menus; physician monitoring; modified diet|
|Montana||Yes||Comply with food service establishment act and food service establishment rules.|
|Nebraska||Yes||Menus designed for food preferences of residents; nutritional requirements|
|Nevada||Yes||Menus ; special diets; nutrition specifics|
|New Hampshire||Yes||Follow 2005 Dietary Guidelines for Americans|
|New Jersey||Yes||Diet manual; nutrition specifics; advisory resident dietary services to include: dietary observances for national and religious holidays; fresh fruits and vegetable served on a daily basis; 3 main entrees at each meal; resident participates in meal planning and facility sponsors a guest meal program.|
|New Mexico||Yes||Nutrition specifics; menus; therapeutic diets|
|New York||Yes||Diet manual; nutritional adequacy; menus; therapeutic diets|
|North Carolina||Yes||Menus; nutritional needs|
|North Dakota||Yes||Menus; therapeutic diets; snacks; substantial evening meal requirements|
|Ohio||Yes||Weight loss or gain policy; menu; records kept 1 year; special diets|
|Oklahoma||Yes||Nutrition specifics; nourishment available at any time; substitutes; diets; menus|
|Oregon||Yes||Diets and menus; documentation|
|Pennsylvania||Yes||Menus; therapeutic diet manual|
|Rhode Island||Yes||Menu planning; diet orders; diet manual|
|South Carolina||Yes||Diet requirements; planning of menus; resident cultural and ethnic needs|
|South Dakota||Yes||Nutritional adequacy; substitutions; therapeutic diets; written menus; diet manual|
|Tennessee||Yes||Menus; nutritional needs; therapeutic diet manual|
|Texas||Yes||Menus and nutritional adequacy|
|Utah||Yes||Nutrition Specifics; menus; posting of menu|
|Vermont||Yes||Same as Federal Categories|
|Virginia||Yes||Menu; nutritional adequacy; diet manual; retain menus 12 months|
|Washington||Yes||Meal provision; individual needs; orders; tube feeding|
|West Virginia||Yes||Diets; therapeutic diets; resident right to request substitute foods even when this violates physician orders|
|Wisconsin||Yes||Menus; therapeutic diets; vitamin and mineral supplements|
|Wyoming||Yes||Same as Federal categories|