10/22/2026

Survey Tip of the Week: Tube Feeding and Dehydration

Under F693, §483.25(g)(5) Tube Feeding, facilities must ensure that residents receiving enteral nutrition receive appropriate treatment and services to prevent complications, including dehydration, aspiration pneumonia, diarrhea, vomiting, and metabolic abnormalities. The Long-Term Care Survey Process (LTCSP) includes a question specifically addressing dehydration for residents receiving tube feedings. Surveyors will ask residents, “Have you been dehydrated since receiving a tube-feeding?” A resident's response may prompt further investigation into whether the facility has appropriately assessed and monitored hydration needs and implemented necessary interventions. CMS notes that care of the feeding tube includes defining the frequency of and volume used for flushing, including flushing for medication administration, and when a prescriber’s order does not specify.

Facilities should review their processes for ensuring adequate hydration for residents receiving tube feedings. This includes verifying that individualized fluid requirements have been assessed, prescribed water flushes and additional hydration are administered as ordered, and staff monitor for signs and symptoms of dehydration. Documentation should demonstrate that changes in hydration status are identified, communicated to the practitioner, and addressed through appropriate interventions.