Investigation Uncovers Food Insecurity in Nursing Homes

Takeaways

• A recent investigation found many nursing homes spend less than $10 per day on food per resident, raising concerns about malnutrition and food quality.
• There has been an increase in food-related sanctions, dietary complaints, and disease outbreaks in nursing homes.
• Residents report unappetizing food and inadequate portion sizes, highlighting a lack of accommodation for dietary needs.

Nutrition plays an essential role in the healthy aging. The American Medical Association (AMA) reports that healthy eating reduces mortality by 20 percent. Adequate nutrition is of particular importance for older adults with complex medical needs who reside in long-term care facilities.

Yet, a recent journalistic investigation has identified problems with food in nursing homes across the United States. The report raises concerns that many long-term care residents are at risk of malnutrition, foodborne illness, and neglect that manifests as limited access to quality food options.

Many nursing homes — acquired by private equity firms in the wake of the pandemic — cut food costs, with more than a quarter of nursing home operators spending less than $10 per day on food per resident and some spending as low as $4 a day, according to the report published by NewJersey.com.

Long-term care facility operators may be cutting food costs because there is no federal minimum standard for food spending per resident. Operators may see food as a less-regulated area to reduce spending.

Nursing Homes

Many people rely on nursing homes for 24-hour care, as these facilities provide housing, medical assistance, and meals. The Kaiser Family Foundation (KKF) reports that over 1.2 million individuals reside in nursing homes in the United States. According to the Centers for Disease Control and Prevention (CDC), of the 15,300 nursing homes in the U.S., 70 percent were for-profit in 2020.

Nursing homes are expensive, with costs representing a significant financial responsibility for individuals and their families. In 2024, the national median cost of a private room in a nursing home ranged from $9,733 ($320 a day) to $10,645 per month. While Medicaid covers the cost of a Medicaid-certified nursing home care for individuals who qualify based on need, these individuals often reside in lower-quality nursing homes, per research published by the National Library of Medicine.

People residing in nursing homes constitute a vulnerable population with complex medical needs that make independent living more challenging. According to the Alzheimer’s Association, almost half — 48 percent — of nursing home residents have Alzheimer’s or related dementias.

Given the vulnerability of those in nursing homes and the high cost of long-term care, it is surprising and heartbreaking that food insecurity is a real concern in nursing homes across the country.

Highlights From the Investigation

Reporters reviewed thousands of federal cost reports filed with the Centers for Medicare and Medicaid Services. They worked with Rutgers University academics and data experts to identify several troubling findings in addition to low food-spending in nursing homes:

• Writeups for food-related sanctions tripled from 2021 to 2024.
• Dietary complaints to ombudsman offices increased by more than 50 percent from 2020 to 2023.
• Disease outbreaks, such as E. coli, listeria, and salmonella, are on the rise in nursing homes nationwide. This is worrisome as foodborne illnesses can be especially harmful to older adults
• Residents interviewed commonly complained that the food was unappetizing — even when it met nutritional standards. One resident commented that the food in prison tasted better. Another resident stocked up on canned goods in his room.

Food access was another concern the investigation highlighted, with facilities offering small portions — such as a single ravioli or a rationed cup of milk. This is particularly troubling as individuals who live in nursing homes already face a greater risk of malnutrition and dehydration.

The investigation also found a pattern of facilities not accommodating residents’ needs, such as failing to provide soft food for those without teeth and not providing bananas to a woman who needed more potassium per her doctor’s orders.

The report suggests that many nursing homes have significant room to improve in how they feed residents. For those navigating long-term care options, these findings are concerning. Older adults considering long-term care and their families may wish to consider how much a nursing home spends per resident on food, whether fresh fruits and vegetables are available, and how the facility accommodates dietary needs and restrictions.

Work With an Elder Law Attorney

If you have concerns about a loved one in a nursing facility, be sure to reach out to a local elder law attorney or the long-term care ombudsman in your state.

An elder law attorney can assist long-term care residents by advocating for their rights and helping to ensure they receive quality care. They can address issues such as substandard treatment, lack of access to food, and financial exploitation. Attorneys also can help navigate complex regulations, resolve disputes with the facility, and ensure compliance with care plans. If abuse or neglect is suspected, they can file complaints and pursue legal action to protect the resident.

For related reading, check out the following articles:

• Recognizing Malnutrition in Older Adults
• Free and Inexpensive Meal Delivery Options for Seniors
• Getting the Medicare Grocery Allowance
• What Are Nursing Home Residents’ Rights?
• Instacart to Help Older Adults Address Food Insecurity