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Dietary Services - Paid Feeding Assistants

Description of Federal Requirements
Comparison of State Requirements
Table Comparing States
Complete Transcript of State Requirements on Paid Feeding Assistants (PDF)

Federal Regulations & Related F-tags for 483.40 Applicable Federal Regulation
(a) Staffing | F361
(b) Sufficient Staff | F362
(c) Menus and nutritional adequacy | F363

  • 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 Asststants
  • Description of Federal Requirements    (TOP)    (NEXT)

    483.160 Requirements for training of paid feeding assistants. 

    (a)    Minimum training course contents. A State-approved training course for paid feeding assistants must include, at a minimum, 8 hours of training in the following:

    (1)   Feeding techniques

    (2)   Assistance with feeding and hydration

    (3)   Communication and interpersonal skills

    (4)   Appropriate responses to resident behavior.

    (5)   Safety and emergency procedures, including the Heimlich maneuver.

    (6)   Infection control.

    (7)   Resident rights

    (8)   Recognizing changes in residents that are inconsistent with their normal behavior and the importance of reporting those changes to the supervisory nurse.

    (b)   Maintenance of records. A facility must maintain a record of all individuals used, by the facility as feeding assistants, who have successfully completed the training course for paid feeding assistants.

    Comparison of State Requirements    (TOP)    (NEXT)

    NOTE:  The examples below may not list all States with similar language; always check your state for specifics.

    For states that have paid feeding assistant regulations, the regulations are often extensive and cover similar topics as the Federal regulations, although in greater depth. Mississippi, Wisconsin, Delaware, Montana, and Oregon provide excellent examples of extensive dining assistant training curriculum. Because it is impossible to cover the entire extent of these regulations in this brief summary, an effort is made to provide information on some differences between states in definition and title of feeding assistant, required hours of instruction, a sample of curriculum and instructor requirements.

    State Definition   (TOP)  (NEXT)

    Alabama has extensive regulations covering the paid feed assistant program. The state definition of a feeding assistant means a person who does not meet the definition of health care personnel and who is paid by a nursing home, to assist residents who have no feeding complications with the activities of eating and drinking. Paid feeding assistants must be at least 16 years old and must work under the direct supervision of a registered nurse or licensed practical nursing in a dining room or other common area. Facility staff who are not health care personnel can be used as feeding assistants upon successful completion of an approved training program. The feeding assistant is not permitted to perform other nursing or nursing-related duties such as measuring or recording output, transferring and toileting. 

    Colorado defines feeding assistant as an individual who assists residents by performing feeding assistant tasks, meets the state requirements and is paid as an employee of a facility; used by a facility under arrangement with another agency or organization; or, who is an unpaid volunteer. Besides the health care workers, families and private duty aides and students in nursing education programs and other allied health programs who utilize facilities as clinical practice sites may provide feeding assistance to residents without meeting the state course requirements. Volunteers must meet state course requirements. Feeding assistants may not be counted toward meeting or complying with any requirement for nursing care staff and functions of a facility, including minimum nurse staffing requirements. Feeding assistants may perform feeding assistant tasks in a resident room for a resident who is unable or unwilling to dine in a congregate dining area upon determination by the charge nurse. Feeding assistants shall know how to use resident call systems. 

    In Delaware, a feeding assistant is defined as an unlicensed, uncertified person trained to assist residents with nutrition and hydration who has successfully completed an initial training program and has demonstrated competency. 

    In Georgia, the term dining assistant means an individual employed or compensated by the nursing home, or who is used under an arrangement with another agency or organization, to provide assistance with feeding and hydration to residents in need of such assistance. In North Dakota, a paid feeding assistant means an individual who has successfully completed a department-approved paid feeding assistant training course and is paid to feed or provide assistance with feeding residents of a nursing facility. Ohio defines a “dining assistant” as an individual who meets the requirements specified in the state rules and who is paid to feed long term care facility residents by a long term care facility or who is used under an arrangement with another agency or organization. 

    Illinois and Rhode Island use the name “resident attendants” to mean an individual who assists residents in a facility with the following activities: eating and drinking. The term does not include an individual who: is a licensed health professional or a registered dietitian; volunteers without monetary compensation, a nursing assistant or person who performs any nursing or nursing-related services. 

    In Indiana, a dining assistant is not allowed to assist more than 2 residents at any one time. In Oregon, a dining assistant means a person 16 years of age or older who has successfully completed a Department-approved Dining Assistant training course and competency evaluation. Dining assistants include volunteers participating in facility volunteer programs who feed residents. 

    Iowa refers to dining assistants as “paid nutritional assistant” and defines them as an individual who meets the state requirements and who is an employee of the facility or an employee of a temporary employment agency employed by the facility. A facility may use an individual working in the facility as a paid nutritional assistant only if that individual has successfully completed a state-approved training program for paid nutritional assistant.

    Required Hours and Curriculum   (TOP)  (NEXT)

    In Alabama, 9 hours of classroom instruction and hands on training is required. Training must include an experienced staff member demonstrating the correct way to feed a resident who requires minimal assistance with feeding including appropriate cueing, moderate assistance with feeding and a resident who requires total assistance with feeding. The program must provide instruction on the following topics: characteristics of the population and meeting needs of persons with a dual diagnosis. Feeding assistant training programs must use a training curriculum, which has been pre-approved by the Department and determined to comply with the federal requirements. Alabama provides a list of pre-approved, standardized curriculum models in their regulations. After completing the training course, the individual must pass a State-approved standardized written quiz with a minimum score of 80%. The individual may request the quiz be administered orally and successfully demonstrate 1) feeding residents with minimal assistance/moderate assistance with cueing and total feeding of resident; 2) Heimlich maneuver; and 3) appropriate hand washing techniques. 

    In Colorado, the feeding assistant training program shall be administered by an approved training program provider and shall consist of not less than 12 actual hours of classroom instruction. Class size shall be limited to 20 enrollees and shall conform to the “Feeding Assistant Curriculum Specifications and Program Requirements” available from the department. Successful completion of program requires individuals obtain a score of 80% or greater on written examination. Within 10 days from successful completion the persons must be given a completion document. A person who successfully completes the program is not required to repeat program upon employment or upon providing volunteer feeding at another facility unless person has not worked in LTC for 24 consecutive months.

    In Delaware, the program shall be a minimum of 12 hours to include classroom instruction and demonstrated competency. A sample of content includes: feeding assistant role and function; on the job conduct, appearance, grooming, personal hygiene and ethical behavior; knowledge of “chain of command” in the facility; residents rights; psychosocial f actors; verbal and non-verbal communication and interpersonal skills, religious, ethnic and personal food preferences; appropriate responses to resident behaviors; learning appropriate use of call systems; nutrition/hydration; feeding techniques; social environmental factors and special needs.

    In Georgia, the minimum requirements of the dining assistant training program shall include a minimum of 16 hours of training and shall include competencies in: feeding techniques; assistance with feeding and hydration; communication and interpersonal skills; appropriate responses to resident behavior; safety and emergency procedures; infection control; resident rights; reporting requirements and recognizing changes in residents.

    Illinois  requires the resident attendant be able to speak and understand the English language or a language understood by a substantial percentage of the facility’s residents. The facility based training and competency program shall be at least 5 hours in length and be specific to the needs of the residents and includes the anatomy of digestion and swallowing; feeding techniques; developing an awareness of eating limitations; potential feeding problems and complications; resident identification; necessary equipment and materials; resident privacy; hand washing; using of disposable gloves; verbal and nonverbal communications skills; behavioral issues and management techniques signs of choking signs and symptoms of aspiration; and Heimlich maneuver.

    Indiana requires a dining assistant to complete 16 hours of training composed of 8 hours of classroom instruction prior to any direct contact with a resident and 8 hours of clinical instruction. Iowa requires a minimum of 8 hours of training. Each student shall complete a 50-question multiple choice written test and must obtain a score of 80% or higher. In addition, the student must successfully perform the feeding of a resident in a clinical setting. A registered nurse shall conduct the final competency determination. Maryland and Minnesota require a minimum of 8 hours of training and Montana requires a minimum of 8 hours of training, 6 hours of which must be in classroom instruction and 2 hours in clinical demonstrations.

    Ohio and South Dakota require the training course for dining assistants shall provide a combined total of at least 10 hours of instruction, including a one-hour clinical portion. The clinical portion shall be provided for no more than 8 participants at one time.Ohio and Utah addresses conditions under which the training program can be suspended. Oregon and Texas require 16 hours of training and evaluation. In Utah, the training course for the dining assistant shall provide 8 hours of instruction and one hour of observation by the trainer to ensure competency.

    Feeding Assistant Instructors   (TOP)  (NEXT)

    In Alabama, only an RN, LPN, RD, ST, or OT may serve as a lead instructor and they must have experience in LTC with 6 months experience in the management of persons with dementia. Experienced CNAs and other individuals may assist with training and demonstrations if appropriately supervised. 

    In Colorado, programs shall use as instructors only individuals who have appropriate experience in feeding and hydrating residents and who hold: a valid Colorado license to practices as a RN or LPN; a certificate of registered dietitian; a certificate of speech-language pathologist or a certificate of registered occupational therapist. 

    In Delaware, RNs, advanced practice nurses, dietitians, speech pathologists, or a combination of such professions may serve as instructors. Occupational therapists may be defined as instructors for purposed of training in special needs. 

    Iowa requires all instructors shall be registered nurses. Other qualified health care professionals may assist the instructor in teaching the classroom portion and clinical or laboratory experiences. The ratio of student to instructor shall not exceed 10 students per instructor in the clinical setting. 

    In Montana, the primary instructor(s) of the course must be a licensed health care professional with experience in nutrition and feeding of nursing facility residents. Licensed health care professionals could include licensed nurses, dietitian and speech and occupational therapists. Certified nurse aids and feeding assistants may not be used as instructors. In South Dakota, the program must include instruction from a speech therapist and registered dietitian.

    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 Paid Feeding Assistants.

    483.35 Dietary Services

    Paid Feeding Assistants
    State Goes beyond Federal Regulations? Subjects Addressed: How State Differs From or Expands On Federal Regulations
    Alabama Yes Definition; volunteers & family not required to complete training; training requirements; pre-approved curriculum; instructor requirements; records;
    Alaska No Alaska regulations do not contain specific content for Paid Feeding Assistants.
    Arizona No Arizona regulations do not contain specific content for Paid Feeding Assistants.
    Arkansas No Arkansas regulations do not contain specific content for Paid Feeding Assistants
    California No California regulations do not contain specific content for Paid Feeding Assistants
    Colorado Yes Definition; qualifications; volunteers complete program; supervision; resident selection; training program; program provider approval; policies & procedures; record maintenance; reporting requirements
    Connecticut No Connecticut regulations do not contain specific content for Paid Feeding Assistants
    Delaware Yes Definitions; general requirements; training program requirements
    District of Columbia No District of Columbia regulations do not contain specific content for Paid Feeding Assistants
    Florida No Florida regulations do not contain specific content for Paid Feeding Assistants
    Georgia Yes Definitions; program requirements; records
    Hawaii No  Hawaii regulations do not contain specific content for Paid Feeding Assistants
    Idaho No Idaho regulations do not contain specific content for Paid Feeding Assistants
    Illinois Yes Resident Attendants; definitions; program requirements
    Indiana Yes Program requirements; instructor requirements; records
    Iowa Yes Definition; training program requirements; program approval; working restrictions
    Kansas Yes Definition; requirements
    Kentucky No Kentucky regulations do not contain specific content for Paid Feeding Assistants
    Louisiana Yes  Feeding assistants; feeding assistants registry; clinical decisions
    Maine Yes Definition; personnel records; resident care staffing
    Maryland Yes Supervision; program requirements; resident selection protocol; state approved training; instructor qualifications
    Massachusetts No Massachusetts regulations do not contain specific content for Paid Feeding Assistants
    Michigan No Michigan regulations do not contain specific content for Paid Feeding Assistants
    Minnesota No Minnesota regulations do not contain specific content for Paid Feeding Assistants
    Mississippi Yes Training requirements; definition; supervision; competency evaluation; successful program completion; training program approval process; instructor qualification; renewal/re-approval process; supervision; requirements for maintenance/retention of records; certificate; reporting misconduct; federal oversight; survey process; background checks; payment/re-imbursement issues
    Missouri No Missouri regulations do not contain specific content for Paid Feeding Assistants
    Montana Yes State approved training curriculum; instructor qualifications; supervision; resident selection criteria; resident rights; maintenance of records
    Nebraska Yes Staff requirements; program requirements
    Nevada No Nevada regulations do not contain specific content for Paid Feeding Assistants
    New Hampshire No New Hampshire regulations do not contain specific content for Paid Feeding Assistants
    New Jersey No New Jersey regulations do not contain specific content for Paid Feeding Assistants
    New Mexico No  New Mexico regulations do not contain specific content for Paid Feeding Assistants
    New York Yes Feeding assistant training course requirements
    North Carolina No North Carolina regulations do not contain specific content for Paid Feeding Assistants
    North Dakota Yes Definition; program requirements
    Ohio Yes Definition; training course requirements; instructor qualifications
    Oklahoma Yes Purpose; training material definitions; registry; registration; feeding assistant forms; competency checklist; certificate of completion
    Oregon Yes Definition; scope of duties; resident selection; training topics; instructor requirements; supervision; maintenance of records; training curriculum;
    Pennsylvania No Pennsylvania regulations do not contain specific content for Paid Feeding Assistants
    Rhode Island Yes Program requirements
    South Carolina No South Carolina regulations do not contain specific content for Paid Feeding Assistants
    South Dakota Yes Definitions; program approval
    Tennessee No Tennessee regulations do not contain specific content for Paid Feeding Assistants
    Texas Yes State approved training course; supervision; resident selection criteria
    Utah Yes Program requirements
    Vermont No Vermont regulations do not contain specific content for Paid Feeding Assistants
    Virginia No Virginia regulations do not contain specific content for Paid Feeding Assistants
    Washington No Washington regulations do not contain specific content for Paid Feeding Assistants
    West Virginia No West Virginia regulations do not contain specific content for Paid Feeding Assistants
    Wisconsin Yes Definition; training requirements; standardized feeding curriculum; successful training program completion; qualified instructor; approval process; employment requirements; current single task worker grand-parenting policy; training program operation; program record retention requirements; caregiver misconduct reporting requirements; survey process; prohibition; program suspension or termination; appeals
    Wyoming No Wyoming regulations do not contain specific content for Paid Feeding Assistants

    Complete Transcript of State Requirements on Paid Feeding Assistants   (TOP)