Feeding assistants will not be required to complete any kind of test or demonstration of competence and will be permitted to feed residents in their rooms without any direct supervision. The proposed rule, issued in March of last year, required feeding assistants to work under the direct supervision of a nurse who was “immediately available to give help.” The final standards, however, indicate that feeding assistants will be expected to call a supervisory nurse on the resident call system when there is an emergency or a need for help.

“These regulations will allow workers who are virtually untrained to work virtually unsupervised with people who are frail, suffering from multiple medical conditions, and unable to feed themselves,” said Donna Lenhoff of the National Citizens’ Coalition for Nursing Home Reform (NCCNHR). “Read these regulations carefully. They would permit a 16-year-old on a wing without a single licensed nurse to perform the Heimlich maneuver on your 90-year-old grandmother if she choked. If she continued to choke or went into cardiac arrest? These regulations say this 16-year-old with eight hours of training in nursing care should ring the call bell for a nurse.”

Nursing homes have lauded the rule changes, claiming they will help to free up nurses and nurse aides to perform more complex tasks. But the new standards may actually exacerbate staffing problems by encouraging nursing homes to hire low-paid feeding assistants instead of nurses’ aides.

Rep. Charles Grassley (I-IA) and Rep. Henry Waxman (D-CA) sent a letter to HHS Secretary Tommy Thompson urging him to reconsider the new standards. “Feeding an elderly resident who may be uncommunicative and may have difficulty chewing or swallowing is a complicated task that should be performed only by skilled and properly trained and supervised personnel,” the congressmen wrote.