Dietary Requirements for Nursing Homes

Nursing homes are required to provide nutritious, well-balanced meals and snacks that taste good and meet the specific dietary needs of each resident. The Centers for Medicare and Medicaid Services, CMS, publishes specific regulatory Requirements for Long-Term Care Facilities, which are surveyed by federal or state inspectors every nine to 15 months for compliance 2. These requirements are established to promote quality of life, prevent malnutrition and weight loss, and ensure safe food handling.


Menus must be approved by a qualified dietitian and be planned in advance and must be followed in order to ensure each resident receives the recommended daily nutritional allowances for his or her condition. Substitutes of equal nutritional value must be made available to residents who refuse food served and should accommodate food preferences as much as possible.

Meals and Snacks

Nursing homes are required to serve at least three meals per day and a snack at bedtime, spaced appropriately apart and served in accordance with community standard timing. Special accommodations should be made for residents who choose to eat at different times. Food must be palatable, thoroughly cooked, not burned, bland or too spicy, attractive, colorful -- or at least not all the same color. It also must be presented in a manner that is appealing and served at the appropriate temperature, hot foods served hot and cold foods served cold.

Special and Therapeutic Diets

Food must be served in a form -- soft, ground, pureed or thickened -- to meet the needs of residents with chewing and swallowing problems. Special equipment and utensils must be provided to help residents eat as independently as possible, although staff must be sufficient in number and have appropriate training to supervise and assist residents who cannot feed themselves.

Therapeutic diets, such as diabetic, renal or bariatric diets, must be ordered by the physician and calculated by the dietitian. Residents with actual or potential weight loss, large wounds or nonhealing pressure sores must receive sufficient calories and supplements to promote healing and prevent further weight loss and skin breakdown.


Food must be handled, stored and prepared in a sanitary manner and must be served at the appropriate temperature to prevent food-borne illnesses. For instance, potentially hazardous foods such as eggs, meat and milk must be kept refrigerated at 41 degrees Fahrenheit or below. Meats should be cooked to at least 165 degrees Fahrenheit; hot foods should be maintained -- usually on a steam table -- at 140 degrees Fahrenheit while being served. In addition, food must only be obtained from sources licensed by federal, state or local authorities. Foods prepared or canned at home and food from unlicensed sources are prohibited.


Nursing home residents and their families have the right to voice concerns and make complaints to the staff of the nursing home, or any other person, without fear of punishment. Concerns regarding food and nutrition should be brought to the attention of the nursing home administrator, director of nursing or dietary manager; and the nursing home must address the issue promptly. Unresolved complaints should be directed to the State Survey and Certification Agency for investigation. The CMS Nursing Home Compare website provides a list of contact information by state 1.