TFA Regulation & CMS Video


In 2003, the Centers for Medicare and Medicaid Services (CMS) published a Federal Register notice allowing long-term care facilities to use Dining Assistants (referred to in the federal regulation as paid feeding assistant ) to augment the services of certified nursing assistants (CNAs/CNTs) for feeding assistance care. The federal legislation had two immediate goals: (1) to increase the number of staff available to assist with feeding during mealtimes, and (2) to provide a set of minimum training and supervision standards for such programs.

In addition to the federal regulation, each state could opt to either allow or not allow such programs in long-term care facilities within each state and publish their own state-level requirements for Dining Assistant programs. As of 2011, all but three states had passed state-level legislation allowing such programs within each state; and, most state requirements go beyond those mandated under the federal regulation. These federal and state regulations are fundamental to a successful Dining Assistant programs because they provide a minimum set of compliance standards for facilities.

Since the publication of the Federal Register, CMS and the Agency for Healthcare Research and Quality (AHRQ) jointly sponsored two studies to evaluate the impact of the regulation on feeding assistance care quality in a sample of facilities that had active programs in place. The results of these two studies have been published and are summarized here (Click on the research article tab on the left).

To date, Dining Assistant programs have expanded to include the use of trained staff both during mealtimes as well as between-meals to assist with the delivery of additional snacks and supplements for residents who are at nutritional risk. This module provides long-term care providers interested in establishing a Dining Assistant program with the education and staff training tools necessary to facilitate this goal.

Centers for Medicare and Medicaid

How to Enhance the Quality of Dining Assistance in Nursing Home