A feeding tube, which delivers Enteral Nutrition (EN), is a medical device used to provide liquid nutrition directly into the stomach or small intestine when a patient cannot safely or adequately eat by mouth. Conditions such as a severe stroke causing dysphagia (difficulty swallowing), head and neck cancer, or recovery from critical illness often necessitate this type of nutritional support. The short answer to whether nursing homes accept patients with feeding tubes is yes, but acceptance is highly conditional on the facility’s classification and its capacity to provide the necessary level of skilled care.
Acceptance Criteria and Facility Capabilities
A patient’s admission with a feeding tube largely depends on whether the facility is a Skilled Nursing Facility (SNF) or a facility providing Long-Term Care (LTC). SNFs are licensed to provide complex medical care and rehabilitation, often for short-term stays following a hospitalization. These facilities have the necessary staffing, including registered nurses available around the clock, to manage the complexities of tube feeding, such as monitoring for complications and performing site care.
LTC settings, which focus more on custodial care and assistance with daily activities, may not be equipped to handle the intensive monitoring and management required for a patient with a newly placed or unstable feeding tube. Federal regulations require that if a nursing facility accepts a resident with a feeding tube, the facility must provide the attention and treatment needed to prevent complications. This requirement ensures the patient receives the necessary professional skilled services.
Facilities may reject a patient if their medical status is too unstable or if the care required is considered acute, such as needing intensive respiratory support or continuous, complex intravenous medications. Furthermore, some nursing homes, particularly SNFs, may prefer patients to have a surgically placed tube, like a percutaneous endoscopic gastrostomy (PEG) tube, over a temporary nasogastric (NG) tube. This preference is often based on concerns about the safety and stability of temporary nasal tubes, though this stance varies by region.
Specialized Care and Management Protocols
Once a patient is admitted, the daily management of a feeding tube requires strict protocols to ensure patient safety and adequate nutrition. The nursing staff is responsible for meticulous tube site care, involving daily assessment for signs of infection, leakage, or skin breakdown around the insertion point. For tubes inserted through the nose, nurses must also monitor the adhesive and surrounding skin to prevent irritation and pressure damage.
Formula administration is a precisely ordered process, executed by nursing staff on a schedule that may involve continuous feeding via a pump or intermittent bolus feeding. Before administering formula or medications, the tube must be flushed with water to prevent clogging and ensure patency. Medications must be administered separately, often crushed or in liquid form, with a flush both before and after to maintain tube function.
A Registered Dietitian (RD) is a member of the care team, responsible for calculating the patient’s specific nutritional needs based on weight, clinical status, and lab results. The RD determines the appropriate formula type, volume, and rate of delivery, tailoring the enteral regimen to meet caloric, protein, and fluid requirements. Nursing staff continually monitor the patient for signs of intolerance, such as nausea, vomiting, or abdominal discomfort, and check for gastric residual volume (GRV) to assess the stomach’s ability to empty.
Financial Coverage for Enteral Nutrition
The cost of enteral nutrition and the associated skilled care depends heavily on the patient’s financial coverage and the nature of their nursing home stay. For short-term rehabilitation following a hospital stay, Medicare Part A covers the entire SNF stay, including the feeding tube, formula, and the skilled nursing services required for its management. This coverage is limited to a benefit period of up to 100 days, provided the patient continues to require skilled services.
If a patient transitions to a long-term custodial stay, the payment structure changes, as Medicare Part A coverage ends. In this scenario, the enteral nutrition supplies and equipment, such as the feeding pump, are covered under Medicare Part B’s prosthetic device benefit, provided the patient has a permanent impairment that necessitates tube feeding. Under Part B, beneficiaries are responsible for a 20% coinsurance after meeting the annual deductible.
For long-term residents, Medicaid is the primary payer for custodial nursing home care, and it generally covers the cost of enteral nutrition, including the formula and supplies. Medicaid coverage varies by state, so it is important to confirm the specific benefits for the long-term administration of EN. Some nursing homes may bill Medicare Part B for the enteral supplies, while others include the cost as part of the daily rate covered by Medicaid or private pay.
Decision Making and Informed Consent
The decision to place a feeding tube and subsequently seek nursing home admission requires informed consent involving the patient, family, and medical team. Informed consent ensures the patient, if they have decision-making capacity, understands the benefits, risks, and alternatives of tube feeding, such as comfort feeding or hand-feeding. This discussion must include the understanding that tube feeding is considered a medical treatment, not routine care, and does not improve survival for conditions like advanced dementia.
For patients who lack the capacity to make their own decisions, a medical power of attorney or surrogate decision-maker is legally authorized to act on the patient’s behalf. Advance Directives, such as a Living Will, communicate a patient’s wishes regarding life-sustaining treatments, including the continuation or withdrawal of artificial nutrition and hydration via a tube. These directives guide the surrogate decision-maker and the nursing home staff in providing care that aligns with the patient’s values and quality of life goals.