Malnutrition in Nursing Homes on the Rise

Malnutrition in Nursing Homes on the Rise

In recent investigative journalism pieces and reports, alarming data has emerged: many U.S. nursing homes are spending less than $10 per day on food per resident. This level of spending is described by experts and regulators as “appallingly low,”. This ultimately raises serious concerns about malnutrition, foodborne illness, and conditions tantamount to neglect.

The federal government’s oversight body, the Centers for Medicare & Medicaid Services (CMS), has reacted by intensifying scrutiny of nutrition in nursing facilities. From a legal perspective, these developments are highly relevant to claims of nursing home negligence and abuse. This means there are issues with inadequate food, spoiled supplies, or unsanitary conditions. In these cases, it may qualify as violations of statutory, regulatory, or common law duties owed by nursing homes to residents.

What the Investigations Reveal

Low Food Spending Across Facilities

• Investigators from outlets including NJ.com, Rutgers University, and others reviewed thousands of cost reports filed with CMS and found that more than a quarter of nursing homes spend under $10/day per resident for food.
• Many more are spending under $12 for three meals a day.

Rising Complaints and Food Safety Deficiencies

• Between 2021 and 2024, the number of food-related deficiencies cited by surveyors nearly tripled, reaching over 9,000 in 2024
• Complaints to ombudsman offices about dietary issues increased by more than 50 % from 2020 to 2023.
• Reports include spoiled vegetables, rancid meat, moldy fruit, meals prepared in unsanitary conditions, even situations where meals were minimal—e.g. a single ravioli for dinner.

CMS Engagement and Regulatory Focus

• CMS has acknowledged these concerns and is “putting nutrition problems … under the microscope.” Investigations are prompting regulators to look more closely at how facilities are feeding residents—not only in terms of what is served, but under what conditions and how much is being spent.
• Although there are federal rules regarding food preparation, nutrition, and safety, there is currently no minimum spending requirement per resident for food in nursing homes under CMS rules.

Legal Implications: Negligence, Abuse, and Liability

Understanding how inadequate nutrition can give rise to claims requires examining the legal obligations nursing homes have and how failing in these respects can amount to negligence or abuse.

Duty of Care under Statutes and Regulations

• Nursing homes that participate in federal programs (Medicare/Medicaid) are bound by regulations that require them to provide meals that meet residents’ nutritional needs, ensure clean and safe food preparation, and maintain sanitary kitchens and storage. Violations of CMS rules (and state regulations) can form the basis for regulatory sanctions and also evidence of breach in civil litigation.
• State laws often establish rights for residents to receive adequate food, potable water, and care that avoids neglect.

Breach: What Counts as Negligence or Abuse

Failures like serving spoiled food, under-portioning meals, ignoring dietary restrictions (e.g. soft foods for residents who cannot chew), or failing to prevent foodborne illness are potential breaches of the duty of care. Under-spending to an extent that makes such failures likely can itself be evidence of negligence.

Harm and Causation

• Malnutrition, weight loss, dehydration, and disease (including foodborne illness) are potential harms that residents suffer. If it’s shown that a low food budget and poor food handling (or a combination) led to measurable harm, that can support claims of negligence or even elder abuse depending on state law.
• Outbreaks of foodborne illness with hospitalization or death, for example, provide concrete proof of harm.

Regulatory Violations as Evidence

• CMS citations or state inspection reports regarding food safety, nutritional deficiencies, or unsanitary conditions can be introduced in civil cases. These inspections are often done contemporaneously and can provide strong documentary evidence.

Potential for Claims under Elder Abuse & Neglect Statutes

In some jurisdictions, statutory elder abuse laws (or nursing home neglect statutes) allow for claims—or even civil and criminal penalties. This happens if facilities fail to provide basic necessities or act in ways that cause or risk serious harm. Persistent under-nutrition, spoiled meals, or unsanitary food handling may fall squarely into neglect or abuse under these laws.

Families should know that these statutes are designed not only to compensate victims, but also to deter facilities from cutting corners on essential care. In fact, many elder abuse statutes permit recovery of enhanced damages. This includes attorney’s fees, or statutory penalties, reflecting society’s recognition that vulnerable residents deserve heightened protection.

By framing poor nutrition as a form of neglect or abuse, residents and their advocates may have stronger grounds to hold facilities accountable when food services fail to meet even the most basic standards of care.

Practical Advice for Residents, Families, and Attorneys

• Ask how much is spent per resident on food — this can often be found in cost reports, inspection citations, or via public records.
• Inspect menus and meal records: Are there proper portions? Is food fresh, palatable, varied, safe? Are dietary restrictions being accommodated?
• Document conditions: Photographs of spoiled food, mold, unclean kitchens; contemporaneous complaints; medical records showing weight loss or malnutrition.
• File complaints: Use CMS, state survey agency, long-term care ombudsman programs. These complaints can trigger inspections and provide evidence in a case.
• Consult with legal counsel if there is evidence of harm attributable to dietary or nutrition failures.

What This Means for Families with Loved Ones in Nursing Homes

For families with relatives in nursing homes, these revelations are both sobering and empowering. They highlight the need to be vigilant about something as fundamental as food.

If your loved one is losing weight, complaining about meals, or showing signs of malnutrition, these may not simply be “part of aging” but indicators of deeper systemic neglect. Families have the right to ask questions about food budgets, review menus, and observe mealtimes.

They also have the right to file complaints or seek legal help if they suspect their loved one’s health and dignity are being compromised. Adequate nutrition is not optional—it is a legal and moral obligation of every facility entrusted with the care of vulnerable residents.

When nursing homes cut corners on food, they are cutting corners on care. Families should know that the law is on their side to demand better.

KBD Attorneys: Advocating for the Vulnerable

At KBD Attorneys, we fiercely represent victims of nursing home abuse, group home neglect, and systemic failures across the United States. Our mission is clear: pursue justice, demand accountability, and drive meaningful reform.

Reach out today for a free and confidential consultation.

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