Opinion ID: 612907
Heading Depth: 4
Heading Rank: 1

Heading: Hydration Requirement

Text: Federal law requires a facility to provide each resident with sufficient fluid intake to maintain proper hydration and health. 42 C.F.R. § 483.25(j). See Woodland Village Nursing Ctr. v. Ctrs. for Medicare & Medicaid Servs., DAB No. 2053 (2006) (whether [the facility] provided the amount of fluids recommended by the resident's dietician can be critical on the issue of adequate hydration). The record supports a determination that Golden failed to properly monitor and maintain fluid levels for R1. Soon after R1 arrived at Golden, the facility's dietician determined R1 needed 2170 mls of fluid each day. Golden's records, however, show R1 never received the recommended amounts of fluids; on many days, she only received 10% of the recommended amount. Even after Payton directed Golden's staff to push fluids, R1's fluid intake did not increase. R1's extreme dehydration upon arrival at the hospital on December 15 is strong evidence that Golden did not properly manage R1's fluids. Golden emphasizes the complexity of R1's condition and the fact that R1 was at risk for hydration overload as a basis for its failure to comply with the dietician's recommended fluid intake. However, Golden points to no evidence in the record showing that it made a care plan decision or provided staff instruction to reduce the fluid level ordered for R1 based on any of her physical problems. In fact, evidence in the record supports the ALJ's conclusion that Golden's staff, including its attending physician, were not sufficiently apprised of R1's conditions to appropriately consider them in their care-taking decisions. Though trained to be alert to hydration issues, L.P.N. Atha did not recall R1 having any problems with hydration and Nurse Payton could not recall if she was notified about the resident's hydration ( id. at 663). Evidence in the record also shows that Golden never properly recorded R1's fluid intake and output and, thus, failed to monitor her to assure sufficient fluid intake to maintain proper hydration and health. Substantial evidence in the record as a whole therefore supports the determination that Golden violated § 483.25(j).