This regulation requires nursing facilities to provide residents with at least three meals daily at regular times comparable to community mealtimes, with no more than 14 hours (or up to 16 hours with resident group agreement and a bedtime snack) between the evening meal and breakfast. Facilities must also make suitable, nutritious alternative meals and snacks available to residents who wish to eat outside of scheduled meal times, consistent with each resident's plan of care.
View official sourceF809 (Rev. 173, Issued: 11-22-17, Effective: 11-28-17, Implementation: 11-28-17) §483.60(f) Frequency of Meals §483.60(f)(1) Each resident must receive and the facility must provide at least three meals daily, at regular times comparable to normal mealtimes in the community or in accordance with resident needs, preferences, requests, and plan of care. §483.60(f)(2)There must be no more than 14 hours between a substantial evening meal and breakfast the following day, except when a nourishing snack is served at bedtime, up to 16 hours may elapse between a substantial evening meal and breakfast the following day if a resident group agrees to this meal span. §483.60(f)(3) Suitable, nourishing alternative meals and snacks must be provided to residents who want to eat at non-traditional times or outside of scheduled meal service times, consistent with the resident plan of care. DEFINITIONS §483.60(f)(1)-(3) A “Nourishing snack” means items from the basic food groups, either singly or in combination with each other. “Suitable and nourishing alternative meals and snacks” means that when an alternate meal or snack is provided, it is of similar nutritive value as the meal or snack offered at the normally scheduled time and consistent with the resident plan of care. GUIDANCE §483.60(f)(1)-(3) Facility staff must ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times. Adequacy of the “nourishing snack” will be determined both by resident interviews and by evaluation of the overall nutritional status of residents in the facility, (for example: Is the offered snack usually satisfying?) This regulation is not intended to require facilities to provide a 24-hour-a-day full service food operation or an on-site chef. Suitable alternatives may be meals prepared in advance that can be appropriately served by appropriately trained facility staff at non-traditional times. PROCEDURES §483.60(f)(1)-(3) Observe meal times and schedules and determine if they are offered at regular times comparable to normal times found in the community. Interview residents to get their input on meal service schedules to determine if they meet their choices and their input regarding eating at non-traditional times and the availability of snacks throughout the day. PROBES §483.60(f)(1)-(3) • Are three meals offered at regular times? • Are snacks and meals available for residents at non-traditional times or outside of scheduled meal service times, or upon request? • Ask residents if they are offered snacks at bedtime. If snacks are not offered, would they want them?