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An article about Feeding Assistants:

Homes enlist feeding aides to help staff

Critics worry the workers will lack the necessary training to work with seniors.

By Brad Heath / The Detroit News

Nursing home regulators are letting homes in many states hire workers specifically to help patients during meals in an effort to ease the pinch of inadequate staffing.

But some advocates, worried the rules will put patients’ well-being in the hands of low-paid employees with far too little training, have asked a federal judge in Seattle to halt the practice.

They fear some homes could actually use the lower-paid “feeding assistants” to replace better-trained, higher-paid employees.

“I don’t think it’s true these feeding assistants would supplement staff; they’re going to replace staff,” said Toby Edelman, an attorney for the Center for Medicare Advocacy in Washington, which is working on the legal challenge. The case still is pending.

Federal regulators first endorsed use of feeding assistants last year, as a way to lessen the demands on the nurse aides who in many homes already struggle to ensure every patient gets enough help eating.

The assistants would get less training than other nursing home employees and would often work part time.

“Staffing is a critical problem in nursing homes,” said Thomas Hamilton, the director of survey and certification for the U.S. Centers for Medicare and Medicaid Services, which regulates nursing homes. “We figured it would not be responsible on our part to criticize nursing for not providing necessary staff if we were not doing our part to try to figure out the best ways by which higher staffing levels could be achieved.”

The agency is studying how well the program works, he said.

Michigan has approached the idea slowly.

Regulators here are putting together a six-month trial in a handful of nursing homes that will give researchers an opportunity to gauge its effect. Many of the details haven’t been finalized.

In addition to the federal rules permitting the change, each state must lay out its own training rules before any feeding assistants can be hired.

Other Midwest states, including Illinois, Ohio and Wisconsin, are pushing ahead more rapidly. This fall, Ohio gave about 170 homes permission to begin hiring the assistants, though most have not yet begun hiring, state officials and nursing home administrators said. Wisconsin has been using the aides longer — it was one of only a few places to allow such specialized help before the new rules took hold.

Wausau Manor, a small nursing home in Wausau, Wis., trained employees who usually run activities at the home as feeding assistants.

“Nursing staff just can’t do it all. Mealtime is probably the most intense time during the whole day,” said Peggy Jones, director of nursing at the home. “It’s just using the staff that are already here and have a relationship with the residents. It’s not a matter of cutting the staff in any way.”

But patient advocates are wary. Helping patients eat is often far more complicated than it appears because many have difficulty swallowing or other problems. The advocates contend less-trained employees could cause more problems than they solve.

“What these new rules do is enable people to come in who have even less training,” said Alice H. Hedt, executive director of the National Citizens’ Coalition for Nursing Home Reform.

Regulators say there’s no evidence that will happen. States such as Wisconsin, which have used aides longest, have reported no problems, Hamilton said.

“The criticisms have been hypothetical criticisms, and I’m not saying they’re illegitimate, but they’re theoretical,” he said.