3.9 Artificial Nutrition and Hydration

Artificial nutrition and hydration is commonly called tube feeding. The most common method of administering artificial feeding and hydration is to use a Percutaneous Endoscopic Gastrostomy tube. The tube is surgically inserted through an opening in the abdominal skin directly into the stomach.

This year, data regarding consent to place a feeding tube was removed because consent to place a feeding tube is usually obtained in the hospital, not at the nursing facility. Since hospital medical records are not always transferred with residents when they enter a nursing facility, information regarding consent to place a feeding tube would not necessarily be documented in the resident's records at the nursing facility.

Proportion with a Feeding Tube

Review of the NFQR data indicates that the proportion of nursing facility residents in Texas who received artificial nutrition and hydration through a feeding tube is relatively low and has changed very little over the past four years. Eight percent of residents received tube feedings this year (Figure 3.9):

2005 — 8%
2006 — 7%
2007 — 8%
2008 — 8%

Use of a Feeding Tube for More Than 30 Days

Residents with a feeding tube in place for 30 days or longer need to be assessed every 30 days by nursing facility staff to ensure that nutritional goals are being met.

In 2008, 53% of nursing facility residents with a feeding tube in place for 30 days or longer were reassessed in the past 30 days (Figure 3.9):

2005 — 41%
2006 — 17%
2007 — 56%
2008 — 53%

Feeding Tube in Place but Not Used

Feeding tubes may be left in place but not used. In this way, residents retain the option of using the feeding tube in the event that the resident is unable to eat or drink by mouth. In 2008, a small proportion of residents had a feeding tube in place but was not tube fed in the past 30 days; only 2% did not use the tube for more than 30 days:

2007 — 6%
2008 — 2%

Feeding Tubes and Residents who have Dementia or are at the End-of-Life

As with the previous four years, NFQR 2008 evaluated whether residents with the following conditions had a feeding tube:

Late stage dementia (e.g., non-verbal or non-ambulatory);
End-stage metastatic cancer or organ failure; or
Poor performance status on Eastern Cooperative Oncology Group (ECOG) performance scale
- The ECOG scale is used "to assess how a patient's disease is progressing, how the disease affects the daily living activities of the patient, and determines appropriate treatment and prognosis" (ECOG, 2008).

Results indicate that the proportion of residents who received artificial nutrition and hydration and who had late-stage dementia or end-stage illness related to advance cancer increased by nine percent from last year to 40% this year (Figure 3.9):

2005 — 38%
2006 — 31%
2007 — 31%
2008 — 40%

Figure 3.9 – Artificial Nutrition & Hydration

Tube feeding [Q9.1]

Did the resident receive tube feedings?

Yes — 8%
No — 92%

Tube feeding supplies nutrition via an artificial or mechanical means into the digestive tract. The most common route of tube feeding is the percutaneous endoscopic gastrostomy (PEG) tube. A PEG tube is surgically placed from an opening through the abdominal skin directly into the stomach.

Of residents who received tube feedings > 30 days [Q9.6]

Were their nutritional goals regularly assessed?

Yes — 53%
No — 30%
Not Applicable — 17%

Of residents who received tube feedings [Q9.3]

Proportion with late-stage dementia or end-stage illness related to advanced cancer

2005 — 38%
2006 — 31%
2007 — 31%
2008 — 40%

Survey conducted: February – July 2008 [Q#.#] = Survey question number (Appendix A) Survey sample: 2,129 from 128,971 residents (Medicare, Medicaid, or any other payer source) living in the 1,044 Medicaid certified nursing facilities in Texas. For further information, contact the NFQR Project Lead at 512-438-3472.

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Updated: June 8, 2010